and i do think that my upbringing has some effect on things. when i talk about the idea of a charity or philanthropy or university being charged hidden fees, i do think there is a ethical element that ways on that that stems from one's religious upbringing. i do think it had some impact. i think it goes to this final line between ethics and legal, and there are too many people willing to make decisions that are technically legal but not necessarily immoral. i think religion in my mind plays a part in that. that is a good question. one last question, and let's wrap it up. >> in order to effect change you have to almost use the kiss principle -- keep it simple, stupid.

could you boil it down to two items on a macro basis -- repeal the repeal of glass-steagall and derivatives, bring it back to where it was in the clinton era because it seems to have worked for 70 years. secondly, on a micro basis would've restrictions such as what happens with morgan stanley where the treasurers get compensated in deferred compensation over five years, would that not create the disincentives to bet the house for next year's bonus? >> to keep it, i agree. the two major history -- regulatory things i am advocating for are the repeal of the two things that happened in the early 2000's that led to a lot of problems. derivatives being re-regulated. the cftc has been sitting on it for two and a half years and has not made a lot of progress.

the second is the volcker rule, which in a sense is a little bit like many of the things glass- steagall stood for. there are certainly people who stand for the full repeal of glass-steagall. there are huge political fears about doing that, but i do think some form of breaking up extremely large banks and disallowing reckless trading activity is noteworthy. i do think the thing about compensation and deferring is essential. but does it fix the problem completely? i do not think so. the truth is that if you swing for the fence in year one and your bonus, things do not work out, you can still leave and go to a hedge fund or go do something else. i do think that the law actually has to become stricter. i think greed and swinging for the fences will always be around. it is impossible to stop. so i think you actually need to

change the root cause, which is if someone gambles with client money or bets against their client, that person needs to potentially go to jail or have some disincentive that is so great that if you're reckless person, there are only two or three things they think about before they endanger the whole house. laws have to change in addition to compensation. but not irresponsible laws, just ones that create curbs that do not allow reckless activity. thank you very much, everyone. [captioning performed by the national captioning institute] [captions copyright national cable satellite corp. 2013] >> coming up live of this afternoon, we'll bring you a

hearing looking at high-risk health insurance pools. the program under the 2010 health care law designed to cover americans with pre-existing medical conditions. witnesses at the hearing will talk about efforts to deal with the problem at the state level. that'll be live in about an hour at 1 eastern here on c-span2. and several live events over on c-span today. in a little less than a half hour at 12:30 eastern, newly-confirmed defense secretary chuck hagel will speak at the national defense university about the fiscal challenges facing the defense department. and later, president obama continues his push for measures to reduce gun violence with a visit to colorado where he's highlighting the state's newly-passed gun laws. we'll have live coverage of his remarks at the denver police academy over on c-span, and that's scheduled to start at 5 eastern this afternoon. >> we have to take back media. independent media is what will save us.

the media are the most powerful institutions on earth, more powerful than any bomb, more powerful than any missile. it's an idea that explodes onto the scene. but it doesn't happen when it is contained by that box, that tv screen that we all gaze at for so many hours a week. we need to be able to hear people speaking for themselves outside the box. we can't afford the status quo anymore. from global warring to global warming. >> author, host and executive producer of democracy now, amy goodman taking your calls, e-mails, facebook comments and tweets "in depth" three hours live sunday at noon eastern on booktv on c-span2. >> at 7 eastern tonight on c-span, our "q&a" conversation

with code pink founder medea benjamin. we want to hear what you think about the group's mission and tactics and how protest movements fit into the political discussion in the u.s. recently, code pink members protested at the confirmation hearing for then-cia director nominee john brennan. >> i'm pleased to be joined by my wife kathy and my brother tom. >> i speak for the mothers -- >> we will stop again. all right. >> pakistan, somalia and who else? where else? >> please remove that woman. >> the obama administration refused to even tell congress. they won't even tell congress we are killing children -- >> please -- >> senator feinstein -- >> if you could, please, expedite the removal -- >> more important than the children of pakistan and yemen! are they more important? do your job! world peace depends on this!

we're making more enemies! >> please proceed. >> [inaudible] >> all right. i'm going to ask -- we're going to halt the hearing. i'm going to ask that the room be cleared and that the code pink associates not be permitted to come back in. we've done this five times now, and five times are enough. >> [inaudible] >> those were code pink protests from john brennan's cia confirmation hearing earlier this year. and tonight at 8 eastern, you can call in and share your thoughts about code pink and other protest movements around the country. joining the conversation -- join in the conversation right now at

facebook.com/c-span. all this week on c-span2, booktv in prime time. tonight reporting on historical events. at 8 eastern, it's "this is the day," and the photojournalism of leonard freed that captured the 1963 march on washington. at 8:45, a reporter for the atlanta constitution jack nelson. and at 9:45, todd and ehrlich with his book, reporting the revolutionary war. booktv each night in prime time this week here on c-span2. this morning on "washington journal," we took a look at efforts to overhaul the immigration system. we spoke with a "usa today" reporter for about 50 minutes. >> host: and we're back with alan gomez of "usa today."

i want to begin with the front page of the newspaper and your story, "border security could kill bill." the how and the when. what are we talking about here? >> guest: we're talking about the idea that, you know, there's been a lot of progress made in the last couple weeks on this immigration bill, and they reached a big agreement over the weekend on some guest worker provisions. but one of the things, you know, looking down the road that could be a really big problem is this idea of how we secure the border. there's broad agreement on the idea that we have to secure it more, from the senate to the white house, to the house of representatives, everybody agrees on that. but how they get there and what that means means very different things to each of these folks. president obama, for example, he thinks that once the bill is passed, all the illegal immigrants who are in the country should be able to start the process to become legal residents and eventually u.s. citizens. in the senate they want to create a new measurement of border security, and once a certain level of border security's reached, then people can start applying for residency

and u.s. citizenship. for positions to start with, the house seems to be somewhere in the middle. so those are the kind of things that when we look down the road at what these negotiations are going to look like proves to be a very difficult thing to overcome. >> host: you quote john carter, republican of texas, i wouldn't vote for the president's fast track, and i wouldn't vote for the senate's slower track. so what's the alternative? [laughter] >> guest: the alternative, i think, is something in between. i think there's different ways of measuring border security, and there's different ways of mollifying their base. so, basically, the republicans one of the things, if there's going to be a pathway to citizenship for the nation's illegal immigrants, a lot of republicans are insistent that the border is, in fact, very secure. back in 1986, the last time that they passed an immigration law like this, there were promises of securing the border, but that obviously didn't happen. so a lot of republicans are worried we're going down that same road again. so i think in the house, for example, some of the things that they've been discussing over

there have to deal with making sure that there's more resources sent down to the border, more border patrol agents, more drones flying over the area to watch for traffickers coming over, more technology, more fencing, things like that. so there's this middle ground of saying, okay, we're not necessarily going to tie the legalization of our nation's illegal immigrants to some pet rick of border security, but saying, hey, if we provide x amount of border agents, if we provide x amount of fencing, of funding down to that area, then that should be enough to get us over that hump. >> host: inside "usa today," alan gomez's piece includes this map. border security to the south. as washington considers a sweeping immigration bill that could legalize the nation's 11 million illegal immigrants, one point of disagreement is how best to secure the 1,969 miles southwest border with mexico to hold off futureaways of people -- waves of people. here's a look at the different

strategies employed by border patrol in the different regions favored by immigrants and smugglers. so if you're interested in that, pull up "usa today" online or buy the newspaper this morning to see all the different strategies that are employed along the border. and that brings us to how we're going to divide the lines this morning. a little bit differently than how we normally do it. if you live in a border state, dial in at 202-585-3880. business owners who have been, you've heard the chamber of commerce business leaders, part of these negotiations with labor leaders, we want to hear from you as well about these provisions that we're hearing about. 202-585-3881. legal and illegal immigrants can call in at 202-585-3882. and all others please call in at 202-585-3883. we want to hear from everybody today. all different sides of this debate as it's happening here in washington. let's talk about the senate plan a little bit. key immigration components that we're hearing about right now.

if you could talk a little bit about them. we talked about securing the border. in this low-skilled worker program. how will it work? >> guest: the agreement that they, that was reached recently, what it does is there's been a lot of disagreement over the years about what they call future flow. you know, part of the reason that we have so many illegal immigrants coming into the country is that there's not a legal, a workable legal system for them to come in and do the work that needs to be done. so one of the agreements that they reached deals with what they call low-skilled, nonagricultural workers. basically, folks who work as janitors, work in hotels and restaurants, in construction, things like that. so what they wanted, what they're proposing or at least what labor and business groups have agreed to and the senate is supposedly considering now is a plan where anywhere between 20 and 200,000 of these workers could come into the country, stay here year round and work those jobs. and then there would be a new bureau that would be created to

kind of increase and lower that number of visas each year as they look at demand, as they look at american unemployment. one of the big concerns is that these people are taking away jobs from americans. so if unemployment is high in one particular year, they might scale back those visas a little bit. so that's one of the areas that they're looking at. they're also considering changes to the agricultural work program. right now there's no limit on the number of visas for what's called h2a visas where they can do agricultural work for a period of time. but the program is very cumbersome, it's very difficult to navigate. you have to go through at least three different federal agencies, several other state agency ises to get those, so they're trying to streamline that in a way that makes it easier for our nation's farmers to bring in some of those workers. and then there's high-tech visas. this is an area that there's very widespread agreement on,

>> guest: it's sort of a legal prospective immigrant, the senate bill has something similar where once the bill is passed, they can apply and be here legally and then after a period of something like ten years, they're allowed to then apply for residency and generally after you become, you get your green card, it's about five years later you can apply

to become a u.s. citizen. so that's the sort -- those are the steps that they have to take, and there's a long list of things that they would have to do, paying pack taxes, paying fines, passing a criminal background check which is absolutely in every single one of these bills. and so where in 1986 there were not many of those conditions there, that one is, this is a far different system that they're setting up. >> host: and the so-called gang of eight in the senate that is working on this legislation includes senators john mccain, a republican of arizona, florida republican marco rubio, lindsey graham, republican of south carolina, and senator jeff flake, republican of arizona. and then on the democratic side it includes senator chuck schumer of new york, dick durbin of illinois, menendez of new jersey and michael bennett of colorado. of -- there's also work being done on the house side. what is the house considering for legislation? what are some of the provisions? >> guest: um, the house side is

a little bit different because while the senate came out and, you know, held a nice press conference and announced that they had come to this agreement and that they were working on these bills, the house has not done that. so there are members in the house that we know are involved in these negotiations. representative mario diaz baa last from florida, representative sow love friend from california and others have been working on this, and they've been working on the this for years now. and this, i think, shows the difficulty of getting one of these bills finally done. they've been working on this for years. there's, you know, alternately they've been described as a secret group, things like that. but they're actively working on it as well. i think sometime next week you'll see either the house or the senate, possibly both, finally file their bills. so it's a little hard to say right now what's in that house bill. in talking to some of the folks involved, it sounds like there's going to be, you know, they have these options, several ways of illegal immigrants being able to get into the country, or being

able to apply to become legal residents. there is a lot of things we see in these other senate and white house proposals, you know, border security, e-verify program that would allow business owners to check the immigration status of their perspective workers. that's something that looks like it's going to be rolling out nationwide as well. so they follow a lot of the same tenets, it's just until we start seeing some of these details, it's kind of hard to figure out. >> host: yeah. and according to politico, ten years to get a green card, pay back taxes, as you said, some similarities in penalties. english proficiency is one thing they add in the house bill and admit to breaking the law. so we're talking about congress readying immigration legislation. of you've heard a lot about the senate work, and as alan gomez said, there is work happening in the house as well. we'll go to our first phone call here. sue in arizona, go ahead, sue. what's your talk on this? >> caller: i'm not happy about it.

i'm, when you talk about how the border, how they measure borderer security, you found like it means, well, if we spend enough money, we'll consider the border secure. and i don't know when john mccain and his group were down here, um, if they drove around the county. first of all, the border patrol's not all on the county. i can't believe -- i can't leave my county without going through a crossing. it's very offensive. there's no reason for me to have to go through a border patrol person to wave me through, slow down my progress. also there's around the county there are huge motor pools with multiple new vehicles sitting this, you know? they've spent money on these uniforms, they spend money on vehicles. that doesn't make us more secure, having the money spent. [laughter] and as far as people making jobs, a lot of these people that if they needed the job, if they weren't being supported by the

government, maybe they would be willing to do a job that isn't ideal. when these illegals become legal and then they get on the government dole, are they going to be wanting to do these jobs, or are we going to have to let more people in? >> host: okay. alan gomez. >> guest: it's a very good question. that's manager that a lot of the officials -- that's something that a lot of officials are really having a tough time with. yeah, do you measure it by what they refer to as inputs, how much money we're putting on the border, how many agents we have on the ground. i mean, from 1993 to now, the size of the border control has increasedcreased from 4,000 to . so, you know, we've been pumping money into that, we've been pushing manpower into it. so that question becomes is it just a question of do you put more people down and then, okay, we move allock, or do you measure it? and then when you talk about measuring border security,

that's a whole other -- >> host: well, yeah. and homeland security secretary janet napolitano said just last week if you're looking for a number, there isn't one that exists. basically saying the border is secure, but there's no proof. >> guest: right. >> host: what does that do to negotiations when the perp in charge -- the person in charge of border security says there's no proof? >> guest: well, to hear members of the house talk about it, i was in a committee hearing a few weeks ago for the first time they started making that point, saying, you know, we might not be able to, you know, give you just one number that you can rely on. the response has been very, very quick from folks in the house. senator jeff flake just this weekend from arizona was talking about how much they need those metrics from the department of homeland security. the way that homeland security explains it is, look, we're using all sorts of metrics. we're using the number of apprehensions, people that we apprehend, we're looking at the seizures of drugs that we're making, we're looking at a lot of things, and that helps them in internally sort of identify what areas they have to hit.

but to be able to produce just a simple number for you guy toss say, hey, the border's secure, that's very difficult. it used to be called operational control of the border. and the last time they checked, that was about 2010, and they estimated that we had about 44% of the border under operational control. then in about 2011 secretary napolitano said we're going to do away with that, because that's not a really fair metric, we're going to create this new thing called the border condition index. they've been working on that for a couple of years now, and they still say they're a few months away from finally finishing that off. so put yourself in the position of a senate or house aide trying to write this into a bull right now, it's incredibly difficult to measure that border and say, okay, now it's good. >> host: jerry, business lake, wisconsin, what are your thoughts? >> caller: good morning, we own an organic farm up here in wisconsin, and i'm not sure people appreciate the scope of this problem as far as personal

relationships go. americans want cheap food. i heard one of your callers say that, um, immigrants take jobs that are less than ideal. wow. my job is less than ideal. that's great. i love that. [laughter] and part of the problem is when we go to hire people, we never know who's coming. the immigrant community so mobile that a we don't know who's coming, and like any other employer, if i have somebody that was experienced, i want that person. i want that person. but if that person's scared away, then i have to train somebody all over again. and as far as unskilled labor, i'm sorry, i object strenuously here. farm work, any kind of farm work -- i know you see the pictures of the immigrants chopping let us, it's not mindless work. it's physically difficult, and you have to concentrate. you have to know what to pick, when to pick. this is not something you can just put a warm body out in the field and do.

so i'm not sure we're coming at this from the right perspective. >> host: can i ask you a couple questions? >> caller: sure. >> host: how many people, you say the immigrant community is mobile. how many people return to your farm in wisconsin during the season? >> caller: we have had three that have returned. that, you know, that we know that we can identify, that we know. but, you know -- >> host: three out of how many? how many do you need? >> caller: i'd maybe estimate a couple of dozen, i really don't know. >> host: okay. >> caller: but it's frustrating, especially if you're trying to build a community. and that's another thing. we live, it's a small village, 800 people, we live just outside. this is a small community. and to try to build a community when you have one whole population being pushed off to the side there, they live over there because this isn't working. and i'm not sure washington appreciates the depth of this mess. >> host: all right. >> caller: and the tone of the callers that, you know, talk about less than ideal work

really ticks people off. [laughter] >> host: okay. jerry, before you go, here's a tweet from joseph ramirez who says is not employer sanctions good border control? what do you think as a business owner? >> caller: i'm not the police. i'm a farmer. i don't have time -- if the federal government would do their job, i could do mine. and if the american people would quit mining and be able to pay what labor is worth, ten we'd all be happy. but like the first caller who doesn't want anybody blocking her way or causing difficulty or anything else, she wants to drive to walmart, buy her cheap food and come home. well, if you want to live like that, take a look around, it has consequences. and i don't think we should be mean to people just because they're immigrants. >> host: okay. so you own an organic farm. can you tell us profit margin? >> caller: i'd be careful here because i have -- we're a producer for organic valley, and i have a nondisclosure.

[laughter] >> host: all right. well, i won't ask you to break that. let me turn to alan gomez. >> guest: i mean, she raises a very good point. this is what i was talking about earlier. the h2a program is designed specifically for farmers. but i think something like fewer than 2% of the farm work that's done in the country is through that h2a program, and that's for many be reasons. it's a very complicated process. the farmers that i've spoken to that use it, i was in north carolina a few weeks ago, and it's a very different image from what she's picturing because in this case this was a farmer that's been using this program for years, you know, as they were getting there on the bus from mexico, greeting them like they were old friends, some of them had been there for a dozen years, 15 years, 20 years, you know, fathers and sons bringing their kids for the first time to start working in the program. so you see how the process could work, and it's very helpful to them. you know, they know exactly what's going on on that farm, they know exactly what they need to do, and that experience that

she's talking about is very important because a lot of times you bring in folks who, you know, be they foreign or american to work on a farm for the first time, it's very difficult. you know, you have to understand what's going on. it's not just, like she said, it's not just hacking away and picking things up. a lot of this stuff takes very, very technical work. but that process is just unusable for so many people. the folks i've met who have used in this, i mean, they have to hire attorneys, associations that do all the paperwork for them. and it's, they put in place all sorts of restrictions you have to do so far in advance that it's hard for a farmer to say i'm going to need 40 workers on this day. you know, spring comes a little bit early and it's time to start working, what are you going to do if they're two weeks late? it's a very difficult process, and that's one of the things they're trying to streamline so farmers like her can have a more reliable work force they can use. >> host: earth them in tampa, florida, legal immigrant. what do you think of immigration

legislation so far? >> caller: um, i totally agree with the lady from wisconsin. i just don't understand why they feel that immigrants come here, and we're trying to get into the market of jobs and stuff, and we're trying to take jobs from floridians or the people in the u.s. because i just feel like, like the lady said, there's a lot of people who get assistance from the government, and they kind of wait on that, and they're americans. they're here all their life, and they get dependent on it. but there's people who come in here and who are really ready to work. they pour their heart into their work, they're very hard workers, and i don't think they should be judged because they are coming from either whatever kind of country. because i do understand that there's people versus just the immigrant from wherever, maybe china or maybe islam or whatever, and they get a lot more help than people if mexico -- from mexico or from the dominican republic. that's where we're from, dominican republic. i don't think that's fair. they do this border patrol, i

mean, it's a funny little saying, but if somebody has to build a border around the united states of america, but i really don't feel like it would be americans who built that border because there's a lot of people here who are dependent. i just don't think they should look at immigrants as one way. of they say we should be treated equal, but they don't treat everyone as equal. >> host: aaron in california, border state there. where are you located? >> caller: near san bernardino. anyway, the lady that just talked, she became a legal resident, and she did it the old way, i would suppose. but she doesn't realize and what most people don't realize is that people, lower-class people, middle class people, they're suffering -- the suffering that we go through. by the calls on c-span, you know that we've been invaded. and i've thought for a long time

that the national guard should come here and protect our country, and the national guard should be used to enforce the laws that are in place now. >> host: all right. let's talk about that point. possibly putting the military to use along our border, or the national guard as a way to say, okay, now, you know, there is border security there, we can go forward. >> guest: i mean, and that's a tactic that's been used in the past. president obama early in his administration assigned it was something like a thousand, 1,200 national guard troops specifically in arizona, i believe. and that ooh -- and historically that's, you know, when there's been flare-ups along the border, that's something that definitely has been used. there are sheriffs along the border who want more of that. spoke with sheriff paul from pinellas county. it's not a border county. >> host: what state? >> guest: arizona, i'm sorry. it's a little bit south of phoenix, and it's one of these

pass-throughs. the tucson sector in arizona is one of biggest funnels for illegal immigrants, for smuggling. it's very, it is very crowded over there, and it's very busy. and he gets sort of the tail end of that as they're all kind of passing through making it to bigger cities and making it to the highways. you know, he wants like 6,000 national guard troops. senator mccain and senator kyl when they, when they proposed border security plan a couple years ago, it involved more national guard troops. so that's part of the equation, and that's part of the question. >> host: what's the cost for all the different provisions that people are talking about to secure the border? i mean, have people put a number out there on how much it would cost? >> guest: there is a lot of different numbers out there. for example, right now i've seen in a recent report where if you look at all the sort of immigration-focused enforcement in the country, it's about $18 billion a year. that includes the southwest border, interior enforcement, everything. and so that gives you an idea of

just how massive that is. that's more than all other federal law enforcement combined when you look at fbi and all those other agencies. so the idea of building a fence along the entire border and providing enough troops to, you know, not be arm in arm along the border, but to fully fund it, it's really hard to know what that number would be. but it's already in the, like i said, 18 billion a year as it is right now. so given the economic situation right now, that's one of the other concerns is how much more can we really invest while we're cutting back on so many other things right now. >> host: doug canyon writes in this: mr. bow mess, don't existing immigration laws trap alien workers in the united states, denying them the ability to return home to their families? >> guest: the -- denying them the ability to return to their families. >> host: well, i think this was -- there was a report put out last week, i believe, in in the arizona republic newspaper

by university of arizona that found existing immigration laws, um, make it so that once people get here, it's so difficult to cross the border. and because of detention policies, they don't want to risk going back home. >> guest: right. no, we've, we've seen sort of a change in the migration patterns. we don't see as many people come to the united states anymore. partly because of how much we've secured the border, partly because the economy has been so poor over the years that those jobs haven't been there. so you do find a lot of people sort of staying static. that flow has definitely fallen considerably throughout the '80s and '90s. we had over a million people a year coming over, crossing that southwest border. as recently as 2004 and 2006 we were still seeing over a million people a year at least being ap rehedgedded along the border. -- ap rehedgedded along the border. -- what we've seen now is 2012 i think there's 364,000 people that were captured along the

border, so that number has significantly decreased. there are people who are staying put more, that's definitely become a new trend in the last few years. >> host: smiley t22 on twitter, republicans just want to keep wages low for businesses. let's talk about some of the players that are involved in this debate. "the washington post" this morning, is mr. rubio on the fence? is he a tea party darling, or the architect of a historic immigration bill? he can't be both, is what they say. if gop stars decide once and for all to lead, that may be enough to sway fence-sitting republicans in the house. if they waver, in this attempt at immigration reform like those of past years is as good as dead. >> guest: i mean, senator rubio's in a very unique position here. he's, obviously, a rising star in the gop. you know, you can't talk about 2016 without somebody mentioning him as a possibility. so the idea of getting, you know, coming into this group and helping shepherd through an

immigration reform would be huge. the party after the 2012 election came back and was very, you know, forthcoming about the idea that they add to do better with hispanic voters. mitt romney was crushed by president obama when it came to hispanic voters. and so on that front there's a party-wide effort to really at the very least improve the tone when it comes to immigrants, and beyond that trying to get involved in immigration process so that they can do better by them. on the other hand, there's that very big risk that you're going to alienate a lot of conservative folks, a lot of tea party folks who were very much opposed to a lot of these provisions. there's still unquestionably a lot of dislike for this, allowing these 11 million illegal immigrants to get on this road to citizenship. senator rubio was the one that the gang of eight sent out after they announced their plan to sell this to key media. he was on with rush limbaugh, all sorts of other conservative

media, so he's trying to walk that line. you know, i think his conversation with rush was pretty interesting, because by the end of it, you know, mr. limbaugh came back very much like, okay, go forward. we'll see, you know, let's see how this goes. and so it's a very tough balancing act. but, i mean, where you have rubio kind of onboard with this, you've got another tea party senator in ted cruz who just this week has been very, very adamant that he's against this pathway to citizenship for illegal immigrants, allowing them to become residents, allowing them to become citizens. a lot of it comes down to where are you from. senator ted cruz is from texas, and in that state if you look at some polling for republican voters for tea party, folks who identify with the tea party, there's not a lot of love for a pathway to citizenship. if you look at the national picture, yes, majorities of americans in poll after poll support the idea of allowing them to become residents and become citizens. but if you're a house member

from somewhere in the midwest, in some of these districts where you don't necessarily have a lot of hispanic voters to begin with and you don't have that appetite for this broader immigration reform, you know, you're sitting this balancing the good of the party in the future perhaps with your survival. and that is what makes, that's what's going to make it tough getting enough votes in the capitol. >> host: and here is a piece from the hill newspaper on ted cruz saying obama pushing path to citizenship as poison pill to kill immigration reform. what does that do to marco rubio and his positioning inside this group of eight when his fellow senate colleague, a republican and also somebody who won tea party support, is saying something like that? >> guest: i mean, it makes it very difficult, obviously. he's, you know, it's a very hard line that he's trying to walk right now. you know, you saw him, you know, this weekend was a very good example. there was, you know, when business and labor agreed to

this guest worker provision, that was viewed as, you know, a huge, huge get for these guys. that's something that didn't exist if previous attempts -- in previous attempts at reforming immigration. 2007 was probably the closest they came, and that agreement was never there. so everybody was excited. they are on the sunday shows talking about this is the last big hurdle, we're moving forward. and right in the middle of that senator rubio's saying, hey, hold on, there's still a lot of work to be done. kind of putting the brakes on there, showing he's not just kind of rolling over on this. he has to show that he's, you know, he's fighting, that he's engaged, that he's trying to maintain a lot of these conservative principles. so that's something that he's trying to navigate right now. >> host: and we were just showing our viewers "the new york times" sunday edition, rubio says immigration bill still has a way to go. back to the phone calls. kwame in centerville, virginia. legal immigrant. go ahead. >> caller: hi. you know, i'm very surprised

when we talk about illegal immigrants and the border. all we think about is the border, the mexico border. and i'm very surprised, because i know a lot of people don't come through mexico, but you can shot the border down, and you still have this problem. so, and then the second point is one of your callers said, you know, was going to happen if you start giving documentation to all these people doing the low-wage works, you know? so i don't know what she was trying to say, but it seems to me that she'd rather have all these people doing the low-wage skilled, you know, works instead of actually getting into the economy, you know, doing what we can do to help this country. >> host: okay. >> guest: you raise a great

point. i think the estimate is anywhere between 30-40 or 45% of the people who are in the country legally right now did not come through that southwest border. they're called visa overstays, people who came here on a legal visa, on a tourist visa, on a student visa, on any number of visas, and you stayed past your time. and that is one of the big problems, that's one of the things that all sides on this are trying to figure out a way to get a handle on that. right now if you come to the country and you leave, we don't have a centralized way of tracking everybody who leaves. so the idea of creating an entry/exit visa or process is something that we've been trying to develop for a long time but has proved very, very difficult. so that's one of the areas that they're definitely looking at right now. the other aspect is just sort of people who come by sea. you know, it could be as simple as folks who are kind of getting around that southwest border on boats and kind of coming in that

way, but it's also through a lot of other, you know, a lot of, a lot of ocean borders in our country, so a lot of people are coming if that way as well. >> host: and boring file clerk adds this: how can we be sure that our border to canada is secure? glenn in lancaster, california, border state. good morning, glenn. >> caller: good morning alan. you know, this talk is just a lot of talk. we need to enforce the laws that we have. if we can't enforce the laws that we have right now, we're not going to be able to do nothing in the future. >> host: glenn, give me an example. >> guest: well, i'll give you an example. i'm a construction worker. i started in the 1980s, you know? and we've had in this need of legal immigrants taking jobs all over. not just low-paid jobs. they're taking construction jobs that pay $80-$100,000 a year. with farm worker visas, they're

overstaying their visas because our laws are not being enforced. you know, our president did an amnesty thing already through an executive order that's criminal, for criminals. allowing people to stay here illegally. >> host: okay. alan gomez, laws on the bookings right now. >> guest: obama's record on immigration enforcement in the main part of the country is a very tough thing to grade, if you will. on one hand, every year he's been in office the country has set a record for the number of people we've deported. we're over 400,000 a year now. and so on the one hand, you'll get a lot of people arguing he's the deporter in chief, or he's breaking up families, and he's really cracking down on that. on the other hand, he did, you know, for years congress has been looking at a bill called the dream act which would allow young illegal -- people who were brought to the country illegally

when they were children, um, that allows them to stay. at last count, um, he created a program to allow them to stay here legally. at last count there was about 2450,000 of them -- 245,000 of them who have been approved to stay in the country legally. and so, you know, you've got to balance those two things out. and so it's difficult to sort of gauge where he's at with this. of um, he's been, he's been making very strong efforts. if you listen to secretary napolitano and people in the administration, i mean, they point to their deportation record. they point to the idea that the border, they keep adding folks along the border. and so they want, they have to be very clear thatter the not ignoring this issue, but then when you look at the idea that he's allowing some people who are here as illegal immigrants to stay here, um, it, you know, it makes it a little bit hard to sort of figure out what that middle ground is. the other tipping he did a few years -- the other thing he did a few years ago was allow for prosecute tore y'all discretion. the people that we're deporting,

what we're trying to do is focus on those who have a criminal record, who have, who are some kind of threat to national security. so if you get pulled over, let's say for a traffic stop or something like that and that's about the extent of your illegality, that's the worst crime you've committed, what he's saying is he doesn't want prosecutors going after that person and trying to deport them. he wants to focus on people who have more extensive criminal records. so it's -- but at the same time, when he duds that they say, hey, you're letting some of them go. so i've been in committee hearings where republicans on the committee have been sitting there screaming at napolitano saying, you know, you're not doing anything, you're, you know, you're just forgetting about immigration enforcement while protesters are being shoved out of the back for calling her deporter in chief. so it makes it very hard to figure out exactly, you know, how to truly gauge that. >> host: and then reed williams on twitter asks this: what happened to e-verify? simple but unenforced.

now complex bureaucracy, which congress likes, loopholes and favors. >> guest: e-verify is, at this point, i think, assumed in all these plans. that's another thing that republicans have been very much supportive of. they've really wanted to get this, um, nationwide for years. they've been, in congress they have been trying to do that just by itself. and so that's one area i think it's definitely in the senate bill, it's definitely in the house bill, it's definitely something that the white house is considering. so that's going to go nation wade. and, basically, what that is is when you apply for a job now or if this thing goes nationwide, anybody who applies for a job, your employer's going to have to check with the department of homeland security to check your immigration status. they're trying to make it so that it's very easy for business owners to use, it is online right now, and you can do that very quickly. but there's a lot of quirks in that system that they're trying to work out, um, and right now it's mostly larger companies that use this who have the human

resources departments to work on that. but it's, the question is when you get to every employer in the country using this, smaller companies might have a little difficulty using it. so that's what -- they're negotiating that, they're working on it, but it is part of those bills. >> host: and make minimum wage mandatory for both immigrants on pathway to citizenship to keep fair wages to existing citizens. this is the washington times' front page this morning. a piece about senator schumer who's also playing a role in these negotiations, part of the gang of eight. the headline is "schumer's prison lobby ties alarm immigrant advocates. immigration rights advocates are turning their fire on their own champion, senator charles schumer, demanding he stop taking donations from lobbyists for private prisons which earn money by holding illegal immigrant for the u.s. government. it goes on to say that mr. schumer is chairman of the subcommittee on immigration, refugees and border security and is one of the eight senators working to strike a deal.

>> guest: and that gets back to what we were talking about with the number of people who have been deported. that's, you know, that's that side of it. so there are many -- as the number of people who have been deported has increased, so has the number of people who are imprisoned within the united states on immigration charges. and so you've seen this expansion of prisons dedicated solely to immigration, and a lot of these are, obviously, along the southwest border, but a lot of these are also in areas far away from that, areas like new york where the senator's from. we're seeing more of this. and that's something that, obviously, just absolutely kills immigration advocates, you know, seeing so many more people being incarcerated. um, but at the same time folks are saying, well, we have to enforce our immigration laws. so that's, that's something that they're going to be facing throughout this. >> host: and in "the new york times" recently lindsey graham, the republican from south carolina, and their headline was

"senator's bid to fix immigration starts in his backyard." why is he part of so-called gang of eight? >> guest: it's interesting, he's been involved in these negotiations for years. 2007 back when senator kennedy from massachusetts was pushing this, he was part of that group as well. you know, senator graham we've seen him be sort of, you know, you can describe it as moderate or, you know, willing to engage in these sort of things in the past. and he provides an interesting perspective because he's from a state, south carolina is a state that has seen a dramatic increase in the number of hispanics that are living there, both legal and illegal. and it's in a lot of these areas that have seen these influxes of hispanics over the last 10, 20 years that a lot of these kind of cultural wars, a lot of these economic battles have been fought. you know, a few weeks ago i was -- last week, excuse me, i was speaking with ed gillespie, the former senior adviser to president w. bush, former rnc

chair, and he put together a focus group in south carolina and iowa looking specifically at republican voters and what their views were on this package. um, and what he was saying was that he was very surprised to see that there was a big -- once they sat down and explained all the different provisions of the bill, explained to them that it's not amnesty they're granting them, it's a very arduous process to get on that road to citizenship, once they explained the increases in border security that there was widespread agreement on this proposal. so in places like south carolina where traditionally maybe there have been a lot of opposition, um, senator graham, he's explained this very well, that if he has time to explain it to somebody, that suddenly they start coming around, they start saying, okay, i can deal with that. so he's -- folks from those kind of states are just fascinating to see how they've, um, how they react once they start understanding this process a little bit more. >> host: alan gomez is our guest, covers immigration for "usa today." our topic this morning is

congress readies immigration bills, we're going to spend the next 45 minutes or so, an hour on this topic as well. talking about policy implications coming up next, and we, we'll continue to take your phone calls throughout this. we've divided the lines a little bit differently this morning. border states call in at 585-3880. business owners at 202-585-3881. legal and illegal imgrants, 202-585-3882. all others, please call us at 202-585-3883. we'll go to francis in hidesville, maryland, a legal immigrant. francis, thanks for waiting. go ahead. >> caller: good, thank you. basically, i'm a legal immigrant, but i also know a lot of people that do not have documents. and i think it's time now that the poll constitutions get their act together to -- politicians get their act together to pass this law. i mean, there's a notion in this country that an undocumented

immigrant is somebody who's in the shadows, who's not, you know, paying their taxes when i know firsthand of many of undocumented immigrants who pay their taxes using tax ids, and they do not get -- they get zero benefits out of our tax law. so that's something that needs to be fixed. and also a very important thing is that, you know, i agree with the previous caller that had a farm, that had an organic farm when she says that on the one hand people complain of not having, of having cheap food to be able to buy, but on the other hand they do not want to pay their fair, you know, the -- they don't want to pay the fair value for that food. so it's time for us to get this act together and get this law passed. >> host: francis, what's your story? when did you come here? how? >> caller: i came here about 14 years ago. i was 14. i came here with documents, i came here as a legal resident,

but basically i came here, i was able to go to college, and i graduated from college as well, and right now i'm a software engineer. so i've been able to, i've been basically, i'm proud of what i've been able to achieve, but it pains me to see all the people who have the same aspirations. these kids that are graduating from high school that have their futures and dreams in this country, and they are being always classified as second class citizens by the media and by the politicians many times. >> host: francis, so did you -- where'd you come from? >> caller: i came from the dominican republic. >> host: okay. did you come on a student visa? >> caller: no, i came here as a legal resident. >> host: okay. what do you make of this headline on abc news this morning? you talked about being considered second class citizens. associated press drops illegal immigrant from their style book, the world's largest news-gathering organization will no longer use the word

"illegal." francis, do you have a -- >> caller: yes. i think that's very important because these immigrants contribute greatly to this country. i mean, the main thing that we have is that immigrants contribute even, you know, when we go to, when we go to many different shops to buy food, when we go to different stores like macy's or any other ones, they purchase with real money, and that drives the economy. and our country, you know, the united states needs to realize the value that we bring and that we immediate to be able to -- we need to be able to be recognized for those efforts that we make for country. >> host: okay. alan gomez, what are your thoughts on the associated press deciding to drop "illegal" from how they describe the population? >> guest: that's been a big debate for the last few years, obviously. the, you know, as far as -- there's a push out there,

obviously, to using that phrase dehumanizes them, makes them, sort of captures and a labels them in an incorrect way. for "usa today," i can say that's a decision made above my pay grade. [laughter] i know his to historically, we y partly on the ap for guidance on this. for a long time we viewed it as sort of a middle ground. as with so many things with immigration, it's very difficult to sort of walk that line between two very extreme sides. so on the one hand, we've never called them illegals. we've never called them aliens. on the other end of the spectrum, to call them undocumented doesn't quite fully say the picture. it's not just a paperwork issue. so that's what we've been using historically as the best middle ground, the most sensible that we can find. those are the kinds of discussions that i know we're having internally. you know, ap making that

decision is, obviously, going to affect, make a big difference in terms of who uses it going forward. so i know there's a lot of people very excited about that. >> host: curtis in barbersville, virginia, you're the last phone call for alan gomez, but the conversation continues after that. go ahead. >> caller: yes, thanks for taking the call. i just want to start out by stating that, um, i just wanted to start out by stating that i used to live in southern california. i was born and raised there, grew up there. i'm married to a mexican national who obtained her residency legally and had two wonderful children who are mexican-americans. i am, i'm actually pleased that congress is finally addressing this, but one thing that i wanted to point out is that border security or often times gets rolled up into the immigration issue. border security is not just

about immigration. it's about national security. it isn't just immigrants who are crossing the border. there are people, we've known be this for a while, there's been reports on it, that people from -- who actually intend us harm cross our borders from the south. so border security needs to be taken seriously, but it needs to be taken out of the context of immigration, okay? >> host: let's take that point, curtis. alan gomez. >> guest: he raises a very good point there. there's several parts to this. on the one happened, yes, if you look at the southwest border and just looking at that flow of people coming over, the vast majority are folks trying to work, trying to raise their family, trying to do that sort of thing, but there are drug smugglers, folks who work for cartels who are establishing themselves over here. so there's that side of it. when you look at the idea of the visa overstays that we were talking about earlier, at least two of the 9/11 hijackers were

visa overstays. today had stayed beyond tourist visas, so that's another component of it. so there's definitely a national security component to this. um, and one of the arguments for this big reform and as they're pushing for this, what they're saying is if they reform the future visa system so that people can get here in a legal and orderly way, then all those folks who are on the southwest border, all those border patrol agents, they can then focus on those national security threats more. right now when you talk to a lot of sheriffs, and, you know, i've spent a lot of time along the border now, what they're saying is when you're out there on horseback and you see five people coming up at you on the middle of the night, you have no idea if they're just trying to get out to work in a farm or work somewhere in the country or if they're a drug cartel ready to, you know, pull out their machine guns and kind of go to work. so it's, be you allow, not if you allow, but if you create a system where the people we need

to work are coming here legally, then they can focus better along the southwest border, at our airports, at all sorts of ports of entry, the ways people get in here, the northern border, looking for those threats to national security. >> host: alan gomez, a reporter for "usa today." if you want to follow him on twitter @alangomez is his handle. thank you, sir, for talking to our viewers. >> actually, it's really significant that this mound has been preserved through all these years. at one point there were probably about 30 to 40 of these mounds around the salt river valley. and only a couple of them have survived. most of the mounds were much smaller, about a third to a quarter of the size of mesa grande and its sister mound which survivors also, pueblo grande. so a lot of those were destroyed. and these two grave mounds did survive. and it offers us an opportunity to study them, learn about their

lifestyle and hopefully learn something about how complex their social and political organization was. i've always thought with archaeology one of the great things we have about archaeology is that when we look into the past and see what people did, like building these canal systems here, i think it gives you hope for the future. because if they could do this in the desert with digging sticks, what is it we can't do? >> this weekend booktv and american history tv tour the history and literary life of mesa, arizona, including a look at the great temple mounds built by indians between 1100 and 1400 a.d. standard at noon eastern on -- saturday at noon eastern on c-span2's booktv and sunday at 5 on american history the on c-span3. >> we have to take back media. independent media is what will save us.

the media are the most powerful institutions on earth, more powerful than any bomb, more powerful than any missile. it's an idea that explodes onto the scene. but it doesn't happen when it is contained by that box, that tv screen that we all gaze at for so many hours a week. we need to be able to hear people speaking for themselves outside the box. we can't afford the status quo anymore. from global warring to global warming. >> author, host and executive producer of democracy now, amy goodman taking your calls, e-mails, facebook comments and tweets "in depth," three hours live sunday at noon eastern on booktv on c-span2. ..

of spring break. we are waiting for the chairman, joe pitts, of pennsylvania to gather this session. -- to gavel this session and. [inaudible conversations] >> the subcommittee will come to order. the chair will recognize himself for an opening statement. during the last several years there have been few areas of

agreement between republicans and democrats on how our health care system should be reformed to better serve patients. from the beginning, however, one area that both sides have designated as a top priority is coverage for those with preexisting conditions. in the republican alternative to obamacare, we have proposed $25 billion over 10 years to pay to americans suffering from preconditions from the universal access programs that reform and expanded state based high-risk pools and reinsurance programs. unfortunately obamacare provides only 5 billion in the pre-existing condition insurance plan. with this pcip we will call up for this purpose until january 1, 2014. at the time of the health care laws passage, republicans argued that the funding level was too low but it would not cover all of those it was meant to a. the first real signs of trouble

for the federally administered high-risk pools came in august 2012 when cms reduced payments to providers treating a high number of high risk who enrollees, hitting hospitals especially hard. additionally, the agency cut the number of participating pharmacies that provided certain types of drugs to program enrollees. next on january 1, 2013, cms increased the maximum out of pocket costs for program enrollees by $2250, and mandated greater use of mail order pharmacy. finally on february 15, 2013, cms announced that it was suspending enrollment in pcip altogether, due to financial constraints. all of these actions were taken despite the fact that enrollment in the high risk plans was less

than 30% of wanted and expected. original estimates were that 375,000 people would sign up for the federal high-risk pools. in fact, only, approximately 110,000 individuals have joined. cms is now trying to stretch what is left of the additional $5 billion to cover the those already enrolled in the program until january 1 of next year. what will happen to those people who have pending applications for pcip when cms cut off new enrolled that? what about those, by some estimates, 40,000 people, who would have enrolled during the remainder of this year? they are left without options and without coverage. on march 5, speaker boehner, leader cantor, conference chair

rogers, chairman upton, dr. burgess and i sent a letter to the president asking that he redirect funding from other obamacare accounts to pcip to allow the program to continue accepting new enrollees. although we still hope for a full repeal of the health care law, and to replace, and replace it with other reforms, we've reached out to president obama and asked him to work with us to help those most in need to get coverage and care. we are still a waiting for his response. i want to thank all of our witnesses for being here today. i look forward to your testimony, and i would like to conclude my statement at this time, and since we do not have neither minority members here, i will recognize vice chairman of the subcommittee, dr. burgess, for five minutes for his opening

statement. >> i thank the gentleman recognition. i want to thank the witnesses for being with us today. appreciate you making the effort to be here, because this is an important issue. some of you i have met before. for others this is the first time, but welcome all. we hear a lot that republicans don't have alternatives or other ideas for the replacement of the president's health care law. i know this is untrue. many of you on the panel know it's untrue. if anything, our party has a multitude of ideas. one overreaching aspect of policy that this is the general consensus is that we do need to address the needs of americans with what are called preexisting conditions. as the chairman said that the affordable care act created the new preexisting condition insurance plan him what's especially known as pc. i think award for to that as the federal plan so won't be confused with state plans, but

he was argument duplicative of actions taken by 35 states prior to 2010 that were a free high-risk pools and they serve an estimated, well, over 200,000 americans. it's been shown that state-based programs to play an important role in lowering the cost of cross markets and providing coverage options for those who are faced with a preexisting condition. in some states the federal pre-existing program was merged with the state existing high-risk pool, and an and in os like the home state of texas, the pcip plan operates in parallel to the state pool. however, the federal pre-existing plan is providing coverage to 100,000 individuals, well short of the 375,000 that cms estimated, but still a significant and compelling group of people who all have stories and deserve protection. as a physician, insuring those with precision conditions and ensuring that they have access

to affordable health insurance is a top priority for me. as much as i believe that the president's affordable care act stretched about the constitutionality, and, in fact, i still believe that. i was concerned that if the supreme court felt as i did that day and said, look, this thing is outside the bounds of the constitution, places of the legislative branch, folks will have the rug pulled out from under them who had been in the federal pre-existing program, anything could be barred from merging into a states pool because the federal program had previously provided them coverage. that's why to ensure that that did not happen, i was prepared to answer that challenge and introduce think indeed access to health insurance act of 2012 prior to the court's decision to provide states with the financial backing to decide how best to provide coverage for their populations who would be in this risk pool. i will also note that unlike

many of the complaints that the federal pre-existing program has faced, the bill did not require those with pre-existing conditions to jump through hoops or to remain uninsured, or some unreasonable period of time before being eligible for coverage. there are always stories of those who have done the right thing, insured themselves, and then for reasons kind of beyond their control fall out of the system. they lose their job. they get a tough medical diagnosis and then find themselves forever frozen out of coverage. those were the stories that people thought of, and people did come to us with that concern. the summer of 2009 attends town halls that were held across the country. what did people tells? they were worried about preexisting conditions, they didn't want us to mess up what was already working for argument 65 or 60% of the country, and they should wanted help with costs. and it turns out we failed on all three accounts with the

affordable care act. how many people have aged into the six-month exclusion since the center for medicare and medicaid services made the announcement that the federal program was now closed ask someone who said i'm going to start the clock in october, and i'll be able to enroll in april now finds themselves frozen out of the system. was it because the federal pre-existing program was designed poorly, because its costs were too high? was a because maybe the problem of serious pre-existing conditions existing in a population that wanted to purchase insurance was lower than estimated? we will never know, but it would have been nice to think these things through prior to adopting the affordable care act. i will admit that many of the current state-based programs are underfunded and lack the ability to meet their needs. it's costly to do with these issues. these people are sick. they have multiple medical conditions.

i was prepared to authorize $30 billion. 5 billion was with the federal program allowed. i was prepared to authorize $30 billion. i've got people back in my district, saying that's way too much money. we don't have the money. i'll tell you what, it's a lot cheaper so that $2.6 trillion that this thing is going to cost and would have had to blow up the whole system into to take care of those people that arguably are going to need help. if we're serious about funding these programs and dealing with these issues, these costs are but a drop in the bucket as to what the affordable care act will cost our nation. mr. chairman, i see of already been generous with the gavel. i consumed the time the yield back in my time as well. i have considerably more, and i will provide that for the record, and i'm anxious to hear from the witnesses. i yield back. >> the chair thanks the gentleman, and we do have statements from the ranking members alone and waxman, and i'll ask consent to enter those

into the record without objection so order. we have one panel today, and i will introduce them at this time. on our panel would like to thank them for taking time to come and share their expertise with us today. first is mrs. susan zurface on behalf of the leukemia and lymphoma society. secondly, the honorable mary taylor, lieutenant governor from the state of ohio. and director of the ohio department of insurance. thirdly, doctor sara collins, vice president of the commonwealth fund. fourthly, mr. ron pollack, executive director of families u.s.a. and, finally, mr. thomas miller, resident fellow of the american enterprise institute. thank you all for coming. your written testimony will be made part of the record. we ask that you summarize your testimony in opening statement to five minutes each.

and ms. zurface, we will start with you. you're recognized for five minutes for your opening statement. >> thank you. mr. chairman, and members of the health subcommittee, as a patient with blood cancer it is my honor to share my experience and those of other blood cancer patients as they begin to to utilize the preexisting condition insurance program. i'm a 42 year-old single mother with full-time legal career. i live in rural southern ohio in an area that has been clearly affected by the economic recession. i'm a solo practitioner with a modest law practice, a sizable portion of which is dedicated to serving indigent clients. i have two children to thank for that coverage under their father's medical plan. i am active and strive to keep myself healthy. for the last 13 years i've rarely been ill and had not needed health insurance coverage. after my mother's death in september 2012, i became ill. and after nearly eight weeks i ultimately saw my family physician and he says of tests

were ordered. a we can have laid on january 9, i received the first test results confirming a diagnosis of chronic undescended emphysema, cll, one of the most common types of adulthood leukemias. the bill for that analysis alone was $7600. after follow-up test and a three day stay in the micu at ohio state university medical center i received over $50,000 of medical bills that i could not afford. thankfully the social workers at the hospital enrolled me in ohio's hospital insurance care program, h. kept it because my income met th the threshold form to build aye and hundred% medical coverage. eligibility for h. kept is reviewed quarterly. i've been working full-time since the beginning of february so i will likely lose eligibility for this program. island about the ohio high risk pool program. jacob person in my application, i learned that the program is no longer accepting applications

due to lack of funding. my options are limited. i cannot qualify for medicaid unless my income is low or become disabled. and i cannot afford high premium for high deductible plan. if i'm working in a normal capacity i am always, always exceed the level to maintain continuous assistance through hacp but not by enough to make health care affordable. even without costly treatment my cll requires regular medical care blood screenings and screening for secondary cancers. without the benefit of coverage i have three options. do-nothing anti-financial and health risk, declare medical bankruptcy, or enroll in clinical trials at a financial not medical necessity. the leukemia and lymphoma society's identify three barriers that exist in this program. first six-month wait without health insurance that a patient must endure before coming eligible to enroll. second, premiums that are

prohibitively high, and third, the lack of affordability across networks. i estimate a representative sample of stories from patients have been working with al l. s. as part of my written testimony. wednesday sleet help patients are forced to go uninsured for six months they risk deeper illness or death, bankruptcy, and/or the potential loss of their home. we urge mayors of congress to work together to remove this barrier legislatively. a second significant berry is the relatively high cost of coverage. nearly 80% of the uninsured with high-cost chronic condition are individuals with incomes less than 400% of the federal poverty level. they will likely find pcip premiums unaffordable. future enrollees in the exchanges will be provided subsidize premiums and out-of-pocket spending caps. however, that's not the case with pcip in. furthermore, a small subset of states including pennsylvania

and several others have exacerbated the problem by prohibiting third parties from assisting patients by cutting the cost of pcip premiums. we urge members of congress to enact commonsense reforms to the pcip program, including providing premium support for those patients who may need assistance and by allowing patients to receive third party nongovernment assistance. one final barriers that patients asked is a lack of portability across networks but for many patients, once said together care within a network, it is emotional difficult and cost prohibitive to reestablish relationships with new providers. the pcip allows patients to visit providers outside of a participating network. however, the out of pocket deductibles are double those within the network. there's no out of pocket cap and 50% coinsurance is added to any services obtained. we urge members of congress for

the flexible in your to obtain the health care they require. on half of the leukemia and lymphoma society, and myself, and the over 1 million patients living with or in remission from blood cancer, thank you for the opportunity to speak with you today. we urge congress and administration to work together to insure continuity in the program, as well as policy that could make it more helpful for patients who so desperately needed. >> the chair thanks the gentleman economic and especially thank you for sharing your personal experience for these recommendations. the chair now recognizes lieutenant governor taylor for five minutes. >> mr. chairman, and distinguished members of the committee, thank you for the opportunity to testify this afternoon regarding ohio's experience with high-risk pool program under the affordable care act. my name is mary taylor and i'm ohio's lieutenant governor, and also the director of the department of insurance. states have regular insurance

based on specific needs of their population, economies and insurance markets. under the leadership of different administrations, democrat and republican, over the past 60 years our department has managed and regulate a competitive insurance market for consumers and job creators. because of our regulatory environment, ohio has a very competitive health insurance market with 60 companies writing health insurance business from which ohio's consumers can choose. in order to determine the impact of the aca on ohio's vibrant market, my department commissioned a report conducted by testing in 20 oh the biggest report projected premiums would increase in individual market in ohio between 55-85%. in addition the report projected a substantial shift in how people get the coverage, and other result the size of the individual market and ohio is projected to more than doubled e while the employer sponsored insurance market is decreasing.

in addition to the syntax, the aca does little in reducing the underlying cost of care that has a struggle going to increase in cost of health insurance coverage. this law is a one size fits all national approach to health care that removes the flexibility for states and is laden with very narrow and rigid regulation. more specifically to high-risk pool, the high-risk pool concept can be a useful tool to address access to health insurance coverage if done well. however, implementing them as mandated in the aca is problematic. the federal government oversight of the program led to its unsustainability and ultimately the entirely decision to close enrollment in the program for new participants leaving, a very vulnerable population without access to insurance coverage. ohio's high-risk pool was organized in 2010, and is administered by an ohio licensed private health insurers but it is funded by hhs.

our department retained its general regulatory authority over the high risk pool, click the right to review premium rates and resolve consumer appeal. even though the program administered by ohio was among the most efficient and cost effective in the country, the federal government, the federal management of the high-risk pool program quickly cost disagreements between the two agencies. in 2011, the high-risk pools submitted raced to both hhs and the ohio department of insurance for review and approval. department of insurance approved the rates that were actuarially justified for the to high-risk pool plans using our normal processes. however, hhs refused to approve the rates and directed the ohio high-risk pool administrator to artificially reduce rates for those in the lower deductible plan, and artificially increase rates for those in the higher deductible plan. as regulators, we must ensure that each block a business consultant at one point individuals isn't subsidizing

the cost of another pool of individuals. as a cpa and insurance regular, where a primary concern relates to companies solvency, forcing a company to artificially set rates causes serious concerns and potentially puts the company at risk where a campaign health claims anchored by those individuals and families who have insurance coverage under the plan. eventually hhs and the department ragle to come to an agreement on rates, but, of course, this cost -- cause consumer confusion and pushback renewal dates. shortly after problems with the rates were result, we began having eligibility disputes with hhs. as the primary regulator, the department reserved the right to make final determinations on eligibility but it in these cases hhs demanded the ohio high-risk pool administrator ignored the departments determination and instead followed hhs is the direction. ohioans who are clearly eligible for the high-risk pool a party to our department review were

forced out of the program by hhs causing them to lose their only available source of coverage. after protracted discussion between the department going to do ohio a minister and hhs committee concluded that hhs would not recognize the departmedepartme nt authority to the ohio administrator was then forced to file a lawsuit against both parties seeking clarification from the court as to which party they were bound to fall. an agreement was eventually reached in which the departments right at the authority was upheld, but this album monthlong ordeal demonstrate the federal government propensity to overreach in this regard state regulation of insurance that resulted in harm to consumers in the process. while our pool has come with challenge is to say the least, ma we feel this tool is not without merit. however, as you seek additional funding to allow this program to continue, through 2013, we encourage you to ensure states are given control and flexibility. just as with the high-risk pool in ohio when a federal agency

steps into a role in which they do not have the experience or the expertise to properly understand the issue, they can have severe consequences for the market and consumers. knowing the challenges that lie ahead, i encourage members of congress to continue working toward a better solution. we will continue our work to improve the quality of care in ohio, reduce loss and reform ohio health care system. thank you for my me to the opportunity to testify before you today, and have a happy to answer questions that you have at the chairman's request. >> the chair thanks the gentle ladies for her statement, and i recognize dr. collins for five minutes for opening statement. >> thank you, mr. chairman, for this invitation to testify on the afford will care act preexisting condition insurance program. the major coverage provision of the affordable care act go into effect in january 2014, providing new insurance options for people without health

insurance and sweeping new entrance marker reform to protect people who must by health plans on their own. the congressional budget office projects the combination a new federal subsidies for insurance and consumer protection for newly insured at least 27 people i 2021. the pcip program was one of several provisions of the law that went into effect in 2010 aimed at providing a bridge to 2014 for people who have been particularly at risk of being uninsured or poorly insured. about 135,000 previously uninsured people with health problems who were not able to gain coverage in the individual market because of their health have enrolled in the pcip program since 2010. the program has exceeded in providing transitional purport for thousands of people who are uninsurable in individual markets. 50 state program provided more affordable coverage than people could gain and the most existing state high-risk pools which operate in only 35 states.

and unlike most state high-risk pools, the pcip program offered immediate coverage of preexisting conditions. but the programs limitations were expected from the outset, and demonstrate why high-risk pools in general are an inadequate substitute for the comprehensive insurance market reform and expanded health insurance options that go into effect under the affordable care act nextgen you. the pcip program logo but relative to the millions of uninsured americans with serious chronic health problems reflects the programs lack of premium subsidies. this means the potential benefits are out of reach for the vast majority of the population. 79% of the estimated 7 million people have a high cost health problems have been uninsured for at least six months have annual incomes of less than 400% of poverty, have incomes of less than 2% of poverty. and the texas pcip program, the annual premium for a plan with a $2500 deductible is about $3800.

for a person with an income of about $11,000, the premium would comprise one-third of his income and the deductible 22% of his income. like the existing state high-risk pools premiums in the pcip program have run well short of claims costs. gene hall and janice more than the medical claims relative to premiums or the medical loss ratio's in both state high-risk pools and the pcip program exceed 100%, but that the pcip medical loss ratio's medical loss ratio's are as much as seven times that has high-risk pools in some states. this difference in medical spending between the two risk pool prague rams is likely because the pcip program provides immediate coverage of people's health problems. combined with fact that people must be uninsured for six months, this has likely lead to an over representation of people in the program with serious health problems that have gone untreated for a long parade of time. atop for diagnoses our treatments and the federal program, in the federal program

our cancers, heart disease, degenerative bone diseases, and follow-up care after major surgery or cancer treatment. these conditions comprise more than one-third of claims costs in the federal program. the experiences of both the pcip program and the state high-risk pools demonstrate the profound inefficiency of segmenting insurance risk pool. without the benefit of a broad and diverse group of insured people, both programs operated at a considerable loss, and depend on federal and state financing to fund the enormous gaps between premiums and claims costs. still because of a higher premium cost, both programs suffer from low enrollment. the affordable care act insurance market reform take effect next year, making it possible for people with health problem or who are older to purchase a health plan with a comprehensive benefit package. expanded eligibility for medicaid and premium tax credits for private plans means that

people with low and moderate incomes with health problems will face far lower premiums than they do now in the pcip program. for example, a 50 year-old man with an income of $23,000 would contribute about $1400 annually per private plan offers a state insurance market places next year. in contrast, annual premiums for six year olds at this income level and the pcip program exceed this contradiction by nearly two times in virginia which has the lowest pcip program, to more than 10 times in alaska. starting in january, and from both the pc program and the state high-risk pools will join millions of new and and interstate insurance marketplaces with a diverse age and risk, age and health profile which will help us by the cost of care, across a much broader risk pool. one of the central goals of the affordable care act is to pull

risks and insurance market far more broadly than is the case today. extensive segmentation of risk in the insurance market has fueled growth in a number of uninsured americans over the past several decades. the expense of both the pcip program and the state high-risk pools underscores what a shared responsibility for health care costs across the population and the lifecycle is a center for an equitable and efficiently run health insurance system. >> the chair thanks the gentlelady. mr. paul, you're recognized for your opening statement. >> thank you, mr. chairman. thank you for your leadership in hosting this hearing. thank you -- >> is your microphone on? >> i turned it off. so, let me thank you again, mr. chairman, for hosting this hearing and chairing this hearing. and thank you, mr. vice chairman, dr. vargas, for this hearing. preexisting condition is opposite a very important matter

with respect to what we should do for the large number of people who are affected by. i took a look at statistics for texas and florida. i'm sorry, for pennsylvania, get a sense of how me people have pre-existing health conditions. look at the totality of them. so in pennsylvania, more than one out of four people between the ages, and birth through 64 have a pre-existing health condition. in texas, '80s 22.5%. obviously, the older you get those between 45-64 in pennsylvania its 48%. in texas it's 46.4%. we are not talking about all these people in this hearing, and that's because most of them did protection because they have employer-sponsored insurance. we think that's good. so what do we do with respect to employer-sponsored insurance, and what can we learn from that?

well, and employer-sponsored insurance, we did not deny coverage to people because they have a preexisting condition. and we think that's good. employers don't typically ask new employees if you have diabetes, to have a history of cancer, do you have heart problems? and they don't charge discriminatory premiums based on health savings. we think that's good. we don't deny coverage for critical care that may relate to one's preexisting condition. and we think that's good. we don't charge a perspective woman employee a higher premium because she's more likely to be pregnant than one of her male colleagues. and we think that's good. we don't charge those of us who have a few gray hairs a whole lot more in terms of premiums because of our age, and we think

that's good. and for workers have difficulty paying for premiums, say a middle-class worker who might be getting a salary of $60,000, and yet, his family health coverage now averages over $15,000, one-fourth. we provide them with help. employers provide and pay for substantial part of the premiums. and we think that's good. well, as more and more people lose employer-sponsored insurance, either because employers are finding it too expensive or more employees are going into part-time work or functioning as contractors, i think there's a lot we can learn from that. and the affordable care act helps us do that. because an individual marketplace, what the affordable care act will say, just like we do with employer-sponsored insurance, you are not to deny coverage due to a preexisting condition.

you are not to charge discriminatory premiums because of their health status. you're not supposed to deny clinical care to somebody that fits with their health care problem. we will not charge women a discriminatory premiums. we are going to limit the differential in what is paid for and what people who are older have to pay as premiums compared to younger people. and we provide premium support for those below 400% of poverty. and by the way, with respect to premium support come in pennsylvania they will be 896,000 people eligible for premium support come january 1. in texas it will be 2.2.6 million people. the point of all this is that the affordable care act creates systemic change starting janua january 1 that is truly responsive to the needs of those people who have preexisting

conditions. and while we support changes that would enable those people who right now during this transition period cannot get into the pcip program, that should not be done by undermining the more permanent changes that should be made and will be made under the affordable care act. ms. zurface talk about two different changes in her testimony. about their no longer being a six-month wait, and the need for premium assistance. we agree with there. of course those things would occur starting january 1. so our hope is that there will be clear recognition that come january 1, we have a much better way to do with those folks who have got preexisting conditions, and it will work in a way that is truly helpful to them. >> all right.

the chair thanks the gentleman for his opening statement and recognizes mr. miller five minutes for your opening statement. >> thank you, chairman pitts, vice chairman bridges and members of the committee. preexisting condition insurance plans or pcip represented a poorly designed halfhearted gesture within the affordable care act. primarily minimizing political risks rather than addressing the series problem more immediately and comprehensively. pcip coverage serve more as a cosmetic patch to cover the consequences of slow implementation of complex covers provisions scheduled to begin nearly four years after enactment of the ac. the program have received sufficient funding to do its job seriously. the relatively small amount of funding and limited attention to the programs structural details appear to conflict with the exaggerated rhetoric of the

obama administration in clinton did extensive problem of lack of coverage for tens of millions of americans with existing health conditions were the primary political rationale for enacting the aca's regulatory coverage and financing provisions. the political ideology behind the core policies of the aca to install guaranteed issues, community ratings, mandated coverage, standard benefits and federal regulation of health insurance from targeting the smaller but significant problem of several million americans with limited or no insurance coverage due to serious pre-existing health conditions, and addressing it more effectively. the pcip program managed to solve less of a problem involving fewer americans than traditional state tools had enrolled, but at a higher percentage to loss while still running out of money. pretty good for government work. at the same time it discouraged continuation beyond 2013 of better tested state alternative mechanisms, better funded, high-risk pools.

by setting its premiums for all at no more than standard rates, contrary to the better practices of the older state high-risk pools or h.r. peace, and also imposed a six-month that was uninsured to qualify for coverage, pcip only succeeded in mostly involving very desperate high cost individuals with no other alternative. as state administering pre-pcip, did a better job by charging and roll is somewhat higher premiums, offering less companies of coverage, and focusing on those individuals who present the most serious and costly medical condition that however they, too, still need more robust source of funding to do more jobs more thoroughly and effectively. simply trying to average or hide the same total health care claims costs across a somewhat wider base at the aca approach, and may redistribute them, but it doesn't reduce those costs.

if the forthcoming health exchange, implementation misfired, limited enrollments and adverse selection, and and/or closely resembling somewhat larger versions of state level p6 been more competitive alternatives to current private insurance market. the policymakers should consider the following 10 points. one, recognize that health care markets are local, not national. so to our problems for persons with high-cost conditions. two, the rhetoric of delegating administration a sense of health policy provisions state government need to be matched by the reality of federal officials letting go the tight reins and entrusting state officials with benefits and appeals issues with a much broader outcome oriented federal parameters. three, be very cautious about imprecise estimates, and they are often guesses regarding scale, scope and cost of the medical insurable.

i'll do some -- and other high-cost, high-risk health addition. four, we should commit a generous amount in a series of cat annual appropriations to support continued operations of state hrps and/or restructured pieces. to be revisited upon subsequent evidence of larger and will demand or higher but medically necessary costs. five, publicly subsidizing the high-cost detail of health risk can strengthen the risk of the private health interest market. six, race and subsidized premiums charged for most enrollees and high-risk pool plans, julie's one and 50%, but then provide income they subsidies for lower income people. separate the issue of income support from that of protection against losing or lacking coverage so due to elevated personal health risk. seven, complementary policy reforms can help such as better portability from groups the

individual market provisions with credible coverage, no longer requiring exhaustion of cobra benefits, retargeting premium subsidies, building information transparency mechanisms that reward better patient choices and provider practices. eight, keep as many older state hrps as possible with business after 2013 as an insurance policy against major problems an individual mandate enforcement or compliance. allowing such coverage to be considered qualified insurance under aca would minimize post-2013 disruptions of continuity of coverage. nine, if the overall cost of health care will rise more slowly in english and comes to rise more rapidly in the near future, no amount of subsidized insurance will keep up with the larger problem. finally, the preexisting condition issue is still a largely limited modest problem. to solve it instead of using a political excuse to politically hijack the rest of the private insurance market. thank you.

>> the chair thanks the gentleman. thanks to all the witnesses for their opening statements and i will now begin questioning, and recognize myself i'd minutes for the purpose. mr. miller, let's continue with you. you've given us a great list. win obamacare was enacted into law, you wrote that the program was designed in a way that would lead to an inevitable problem. what principle feature of the principal features, if you could name a couple of preset, allegedly the program would run out of funding? >> it was weighed down by the larger law, but within the provisions of pcip, the two core provisions of course our design is within six much required for uninsured coverage, which created a flaw from the start. and secondly, the massive underfunding relative with the potential range of the problem was. the only reason why some budget estimates said we might get under the white on this, ceo

sibley said we will close down the program when they run out of money. the actuary to readjust basically said the same thing. been provisions written into the law for the pcip administers or hhs to carry out the worst practices of the private insurance they blame which is a simply run out of money, we half of the benefits come close the doors and, therefore, we've met our budget. it's not surprising we got there, maybe we got there later because it was a slow take-up, but in essence it was a program designed to have an early expiration date on the cover. >> thank you. governor, you mentioned a number of administrative problems in litigation. are you still having administrative problems with the fedfeds or with hhs regarding te administration of your pool, all litigation solid? >> the most recent lawsuit, we've come to an agreement on a resolution of that. as i did say in my testimony, we are pleased that the department of insurance continues to be

seen as irregular toward arm of health insurance in ohio because it relates to the high-risk pool. so i this point the two major issues that we face, both the rate issued in 2011, and protecting consumers and protecting consumers coverage in ohio has both been resolved. >> thank you. ms. zurface, can you describe your thoughts at the time when you found out that pcip was not an option did hhs closing the program to applicants? >> i can try to get what sort of an interesting experience for me. i has as indicated above are written in my oral testimony started in february trying to figure out how i was now begin to finance very expensive health venture. one of the things that i came across was the ohio high-risk pool insurance. isa limit specialist at the end of february, and at that time my

special is indicating he would like me to it at a clinical trial. that's having very good results for the treatment and my specific chronic leukemia which is chemotherapy resistant, and a bit more aggressive due to chromosomal mutation. ssoviet suggested that i go ahed and into the clinical trial. at this time i actually took some time to step back from that, being basically healthy at this point and said, i think what to do a bit of time and watch my numbers and see exactly what this catches doing inside my body, and what they need to do to manage it at this time. it was within about a week and a half, two weeks from that point in time that i found that the maybe i don't have the time to step back and do that. because if i do in into the clinical trial, more, sooner rather than later then it's likely that that trial will fill up and there won't be any type of reasonable affordable

treatment option available for me. so i really had to step back and assess when going to do with regard to my health care condition at this time. >> because you are self-employed and not able to work at this time, you as i understand, your treatments are covered by ohio's hospital care assurance program, is that correct? >> at this time as long as i take my share through ohio's state medical send i do qualify under the regulation for the hk program. there's a separate program administered for osu physicians. so a long as a part of my care s managed at osu medical center is covered on the quarterly review basis, so each quarter, they were like my staff and i will have to resubmit income profit and loss information. >> so as long as your income remains below a certain level, this program will cover you? >> yes spent are using it would be more beneficial for your help

-- health to not work and be covered by hf band work full-time, sebastia commitment, you would have no coverage at all? >> i would argue that it's never more beneficial for my help for me to not be working. both mentally and physically, it's better for me to be as active as i possibly can be. from a financial standpoint, it may look like at least on paper that it would be more beneficial for me to not to work on these not worked out a full capacity in order to maintain health care. >> my times expected i have a lot more questions but let's go to the vice chairman, dr. burgess, for five minutes for questioning. >> thank you, mr. chairman. ms. zurface, let me ask you. you are an attorney. actually a physician in my previous life, so we both are in professions that, we went in them to help people. if i understand your testimony correctly, you in fact function as a public defender at some point, is that correct?

>> somewhat. the program that we have in my county, all of the attorneys into areas that practice criminal law actually so does court abounded council but it is very similar to the public defender program. >> you of course are paid for the work, are you not? >> i am speak where does that and come from? >> that money comes out of the county fund to our county commissioners establish an hourly rate or a court appointed counsel. >> well, wouldn't it be better if the federal government just took it over and we paid you for the? >> oh, i was just going to say it's a rhetorical question. i wonder, i wonder how the photo, where that money would come from with regard to the federal government and why would it be better for the federal -- >> is all of the money, take it from someone else at the point of this beer, they give it to us willing after we threatened them with lifetime incarceration. but lieutenant governor, your

discussion of how difficult it is to work with health and human services and center for medicare and medicaid services, can it would be and i can against the federal government taking over the program that the count is so ably administering and taking care of those people who get into trouble of the law but are too intentioned to afford their own lawyer? >> yes. our experience specific to with working with hhs, worked with the federal government has proven to be less than rewarding. i think states are well prepared to regulate insurance as we have done for decades. and i think that these types of issues are best addressed closer to home where you can react quicker, and in a more thoughtful way with regard to market changes, economic conditions, the need of your

citizens. a long way of saying yes. >> you could react quicker and that's important, and you know the people with whom you are dealing. your state is argue argue but ae different from my state, and the needs and the things that we need to be met for the constituents might be different in the two states, and you're in a position and your counterpart in my state would be a position to make those, to have the facility to be able to make those decisions on a much more real-time basis. i just have to tell you, i said that with your counterpart in my state on monday, and, of course, little farther from what we're talking about today but the medicaid expansion, which is being much discussed, and the litany of complaints that come forward from the state folks about trying to do with the center for medicare and medicaid services. they have created the regime over there which is almost impenetrable. so is it any wonder that no one at the state level once to buy, they don't want to buy anymore

of that. they've had enough of it. i certainly understand that, and mr. miller, remember back to 2008 and we talked about this issue of the state risk pools a lot back in that year as i recall. i don't member why we discussed it, but we did. i was a little bit encourage after the summer town also 2009 that i alluded to, and those were somewhat rough events, but we came back to washington in september and the president is going to address a joint session of the house and senate, and i thought oh goody, they've realized the error of their ways and they will put the pause button on your and we will get the reset button. but alas i was mistaken. it was fast forward if anything. one of the things the president said today that really got my attention, or that night, was that senator mccain was right with his approach helping people with preexisting conditions and the expansion of the state pools and reinsurance.

that might be the way to go. and i thought for a brief moment there was a glimmer of understanding, what do you think have been? >> they had some of the music but not all of the lyrics. consensus is often a mile wide and an inch deep. they are are always seeds of agreement between the two sides covet the kind of get overpowered by broader imperative to get it all and implement your program and get it comprehensive. you can find republicans and democrats agree and we need to help people who are in desperate straits, who can't help himself but we need to be generous and kind and compassionate. as a good society. but the there' there is a diffee between doing that and running everybody else's life in microscopic detail. that's what we've got. we would do something so some

people, we can give you an anecdote about, but meanwhile, look at the rest of what the law is going to do. it's turning upside down one of the arrangements that people are quite happy with and would like to continue and will be in a very different world within a year. all these idea that somehow ways us have become young and healthy people will be ready to pay twice as much in the insurance premiums and if one will come out ahead and everybody was subsidies but it's not going to work that way. that's the problem and try to shoehorn people into theoretical arrangements that don't match ththeir preferences or practice. >> thank you, mr. chairman. >> we're going to continue with another round. we've got lots of questions. so let me continue with you, ms. zurface. what do you plan to do now that funding for the new enrollees in the pc program has been told by hhs? >> going to take it one day at a time. i have no choice but to continue with my medical care, so going to continue making my appointments, imagine my care as best i can. do my very best to not incur

great expense to myself and see what's available for me. and updated finish of the hcap program and any similar program that is a fable. i will take advantage of what ever leukemia and lymphoma society is able to offer. i'll just take it one step at a time. >> the added burden of not knowing if your cll treatment will be covered must add unneeded stress to your life as a single mother, does it not? >> it sure does. >> mr. miller, editor hhs's announcement of new applicants would be shut out of the preexisting condition program, we sent a letter to the president asking to work together to redirect funding in the president's health care law to ensure that no sick american is turned away at and as i mentioned one month later we have yet to hear from the president. my understanding is that at the time of enactment roughly 18

programs in ppaca received greater or probable funding than the preexisting condition program. couldn't this funding such as the mandatory appropriations into prevention public health fund provide the resources to help enroll new individuals and high-risk pool pro can? >> it could certain have contributed. the administration appeared has broader priorities which look more at 2014 and what people are going through in 2013. i know some of the money has been taken out of the prevention and public health fund for the doctor fix. that was kind of a bad -- it might be eight or 9 billion depend on how you want to count it for the remaining authorization. that could make a contribution to provide real belief of a tangible nature to a lot of the stuff into prevention public is over on the exotic site. it could be done in the right way but we don't have much evidence it's working in that manner, although more of a political slush fund.

so that would provide some means of conservation. we need more money than that if you want to do this on a longer-term basis and i think the previous proposals for more enhanced funding in a different in private, and i'm not sure if the votes are there to get that right now, but when you're looking at people have a very identifiable condition, these are the folks who want to put any special needs plan. we know that a series condition. they need more intensive medical management. you've already identified the population but it's going to cost money to subsidize. that's something we should do and that should be a higher priority perhaps and subsidizing everyone's insurance although it up to 400% of the federal poverty level, but that's a different political agenda than helping the most unfortunate people right now in ways that can help. >> dr. collins, in your opening statement you said pcip provided immediate coverage for pre-existing conditions. however, this leaves out an important context. didn't the aca require patients to be uninsured for six months before they became eligible for pcip? >> right.

so the intent of pcip program was to provide immediate coverage for people who ha have been injured for a long period of time, released -- intimately cover their preexisting conditions. as mr. miller pointed out, most state high-risk pools do not cover your bases in addition right away. said intent of the law was to cover people's conditions immediately. the intent was also to provide insurance coverage to people who did have health insurance coverage. so that was very clear in the law. it was designed as a transitional provision so that people who are uninsured, who at any health care needs, could get coverage over the three-year period. >> well, ms. services testimony indicates that this requirement had real effect on patients destiny seeking coverage for a preexisting condition. in his record a century force patients to let the conditions deteriorate while they waited

for the arbiter six-month waiting for you to run that? >> it was sort of difficult for people who had wait to get coverage. it's one of the characteristics of our current insurance system that will go away next year where people are prevented from pursuing careers like this surface is right now in terms more flexibility in their job, their jobs education pursued because they have to not make above a certain amount of money to maintain the health insurance coverage to all that goes weight in january so that people don't have restrictions on what they can do anymore in their careers just to maintain their health insurance coverage. so this was, again, a transitional provision. there were several transitional provisions in the law. this wasn't the only one. annual limits on what health insurers can place on your benefit. so this is part of a large number of provisions that went in right away that they provide coverage to a lot of people who really needed them, young

adults, about 6 million came on defense policy over the last year. they were in no way designed as the endpoint in the provision, but is really a beginning point of transition. >> i want to get one more question. mr. pollack, does it concern you that it administration has cut off funding for this program? >> obviously i'd like to make sure that everybody who has a pre-existing health condition can get coverage. and it is very concerning that people have a preexisting condition, like ms. zurface, our right now without the opportunity to get the coverage they need. but what is very important in terms of the compassion that we've all talked about with respect to people with preexisting conditions, is that come january 1, all these problems are a thing of the past. ..

. .. which will be far more effective than the temporary measure. >> thank you, my time expired. dr. burgess you're recognized for another five minutes. >> undermining the long term architecture. that is elegant way of talking about something, when in reality what we should have been told three years ago before this sign was signed, the dog ate my homework so i will turn in the rough draft. in her testimony she talks about how this particular

provision was not in the bill that passed this very committee in the house side in 2009 but added to the senate finance committee staff added it. in fact most of this was written by the senate finance committee staff. wasn't even written by legislators. the thing was rushed through on christmas eve. a big snowstorm was coming to town. senators wanted to get home for christmas and they they had to vote on it and they voted. they got 60 votes for the affordable care act. now everybody felt, i'm sure chairman waxman were here would tell us he was working on conference committee between christmas and new year's that year. he was preparing himself for the conference committee. of the president came to the democratic retreat. all the discussion was how we will get this ironed out even before the conference and we'll get a bill both the house and senate can support but it didn't happen, did it? because there was a special election in massachusetts. scott brown was elect. first time a republican was elected from massachusetts

since the earth cooled the first time and there were no longer 60 votes in the senate. so harry reid told nancy pelosi, this is it. this is what you get. i can't change it. so, most people don't realize this. hr 3590 was the bill voted on christmas eve. 3590 was passed by the house of representatives in july of 2009. but it wasn't a health care bill then, was it? it was a veteran's housing bill. a veterans housing bill, passed house. i don't think many people voted against it. it went to the senate. sat in the hopper. then it was amended. and the amendment read, strike all after the enacting clause and insort, and this is what was inserted. so here you had a bill passed the house, different form. passed the senate. came back over to the house, and, if you don't change anything, you can sign it into law. that is what the next three months was all about, how to convince enough democrats to vote for the, really what a

rough draft. it would never have done what this thing has done to if it had been fixed. there was not ability to fix it because there weren't 60 votes for any type of fix in the senate. it was the very worst type of process that gave rise to the very worst type of policy and then, for reasons that i will never understand got signed into law and we're dealing with it. we can see it affects real people in very profound ways. i would submit that the letter the chairman referenced to the president, and i realize it is just a bandaid on a problem, mr. miller, but the prevention in public health fund, yeah, we raided it for a lot of things. trade promotion authority. doc fix. let's raid it for this as well. goodness knows it was political slush fund. it was added by senate finance staff for reasons i'm not privy to. i think, mr. chairman, perhaps we can submit again to the president that he reconsider his inaction on this because we have heard

testimony from compelling witnesses today that something needs to be done. before we can all lay down in the fields of the affordable care act of january 1st, 2014, we're going to have to deal with this and the public health and prevention fund i think is the logical place to go. if there is not quite enough money there, let's go to the patients center for outcomes and research initiative. there is a place a lot of dollars are sitting. center for medicaid, innovation a lot of dollars are sitting no reason to have them sit there and let's help real people and help real people today. mr. pollack, in your testimony, you said your calculation, 68 million people have preexisting conditions. and 100,000 are now covered under the federal program. there is a bit of discrepancy between those two numbers, isn't there? >> of course there is and i explained that. the reason -- >> and i accept your explanation. >> discrepancy with respect

to that -- >> let me ask you the question, sir, before my time runs out. >> most of those folks are in employer sponsored insurance. >> correct. >> it has the same attributes on those protections provided in the individual market. >> they begged us, begged us not to disrupt what they were receiving but looks like we have. let me ask you a question. if you thought that this was a serious a problem it was, was the administration wrong puttings only $5 billion toward this problem? >> would i favor more money put into this as the temporary measure? of course i would. and i certainly would like to see the temporary problems that are significant problems that they be fixed. but not, by undermining as i said before, the key architecture of the affordable care. whether it is of prevention care fund, which is very important to promote good health care, it shouldn't be sixness care.

it should be health care. and again i don't think we should be undermining with respect it, with respect to -- >> the architecture underlying the affordable care act is anything but elegant. it is bizarre. it would be the nicest way to describe it. it is macabre. honestly, i can't not, if money is there in other programs, mr. chairman i can not see why the president, the secretary have not responded to what is a very reasonable request from this committee has submitted in written form. and i will just reiterate that i think they should respond and if they don't, i believe we should ask the question again as nicely as we possibly can. i yield back. >> chair thanks gentleman. we'll go to another round, if that's okay. i still have some questions. i think you do. governor taylor, in your testimony you state that ohio commissioned a study to estimate the effects of the affect on premiums when the law is fully implemented. it found premiums will increase by as much as 85%.

recently the society of actuaries issued a report with a similar finding estimating that ohio's individual market could see premiums increases as high as 80%. do these estimates lead you to believe that many will forgo coverage because of the aca's costly requirements? >> mr. chairman, we are clearly concerned by the changes that will be implemented starting in 2014 that are going to very severely negatively impact the cost of premiums in ohio. both studies are somewhat consistent in that premiums in our individual market will rise by as much as 85%. of course from a state perspective, yes i'm concerned. i would prefer to have more flexibility to come up with individual state solutions that solve's ohio problem and texas solve your problem the way it best suits texas and given some flexibility our goal would be to use a more market-based approach

and help make the cost of insurance more affordable and more accessible using free market approaches rather than providing federal subsidies that i think the high risk pool is somewhat look at what we might expect in the future where you have premiums being artificially held down by companies who are pressured by hhs and then ultimately premiums aren't covering the cost of the type of care that is being provided and as regulator, one of our primary concerns is of course solvency of the companies. consumers are severely harmed if companies don't have capital reserves to stay in business to pay those claims and ultimately it is the consumer who will suffer. my preference would be to a market-based approach that reduces cost of premiums for everyone and makes it more affordable and accessible that way? would you continue to elaborate what efforts ohio is undertaking to reform health care in ohio? >> yes. mr. chairman, well, as i stated in my testimony,

unfortunately a lot of what we see in the aca is not dealing with the root of the problem which is how you drive down the cost of health care. really more insurance regulation or changes in insurance regulation. in ohio, we have our medicare and medicaid groups working together so that they're coordinating coverage of individuals that are eligible under both plans in order to save money. we have an office of health transformation that working with individual providers, hospital providers across the country to help better coordinate care between those that receive services for mental health for example, and then, also how they receive services for physical health, doing a better job of coordinating those services to help drive down cost, using technology, and to look at how we provide better care for patients, higher quality, at lower costs. so working both on the medicaid side but also then working on the more private sector side by partnering with providers across the

state. and ultimately it allowed us to hold undo the increases we would have otherwise seen in medicaid so we can have more flexibility how we manage the medicaid program. and also the governor has broken out in this most recent budget separately identified our medicaid director as a cabinet level director versus working for a different agency. >> based on the problems you've dealt with already, could similar regulatory problems occur? do you foresee your state having additional problems with the implementation the affordable care act once the law is fully implemented? >> mr. chairman, if we look back at our experience with the high-risk pool, our statement is pretty much if you want an indication of the future look at the past, of course we're concerned about disagreements with federal regulators both as a tate regulator but then how does that impact consumers,

ultimately impacts consumers, impacts companies. creates uncertainty in the market which makes it much more difficult from an administrative perspective for all of us to deal with the difficult issues. of course we're concerned about the premium increases and costs that that will bring. if you look at ohio's high-risk pool just as an example, we have 3500 people covered in our high-risk pool. the cost ultimately we're projecting costs paid for by the federal government, somewhere between 135 million and a 140 million to provide subsidies for that care. so of course we have a cost issue. then of course i've already stated the concern we have with artificially holding down premiums that ultimately puts at risk the companies that are there to pay the provider claims and pay the claims for consumers. >> thank you. i want to sneak one more question in here. your situation is not a

special case. can you talk a little bit about the number of patients who you reference in your written testimony, who are facing the same government barriers as you do? >> my situation is not a special case and i think that's why i'm here is because it's becoming almost the rule as opposed to the exception especially now that there's not the funding available available for the preexisting condition program. we submitted eight different testimonies in the written transcript that was provided to you. each one of those people is obviously too sick to be before you today, which is why i'm representing those people as well. the problem that we have in trying to identify how many people are being affected is, we're only aware of the people who are being affected when they contact us directly. so we don't know who is having trouble, who got

kicked out of the program, who applied too late to be permitted into the program. we don't know those numbers right now. i do know that the lukemia and lymphoma society is working on making sure we can have additional data to submit to the committee and we'll be happy to provide more written information to you but at this time the only people that we have direct information on are the ones that who's stories are already in the record. >> how about did you hear about the lukemia and lymphoma society and how did they help you during this trying time? >> i had a fabulous experience with the lukemia and lymphoma society. in 2005 shortly after my grandmother was diagnosed with non-hodgkins him moment fa i joined them in training and became an advocate and fund-raiser for them through cycling. so i did that for a season and then many of my friends then met through that

excursion remained advocates for team and training. so i was already familiar with the lukemia and lymphoma society when i received my diagnosis in january. they were the one the first resources i looked up to look if there were any type of premium assistance available. as i am self-employed, one of the things that does happen i can't say i have x-amount of dollars available for monthly income. so on a month to month basis my income may change and fluctuate. so i may have a good month followed by a bad month. i'm sure that a lot of people who are self-employed understand exactly what i mean by that. so what i would need is something to fall back on, a fallback position to even make those premiums on a regular basis to make sure i don't have a lapse in care once i'm able to insured. i was reserving that issue and came back in contact with the lukemia and lymphoma society which actually provide ad symposium in march in

cincinnati and i attended that symposium and reconnected with the agency. so they do have a lot of resources available for people in my situation. >> thank you. and again, thank you for sharing your personal experience and representing the other patients that you have referenced. dr. burgess, you're recognized for another five minute round. >> thank you, mr. chairman. you sure you want to do this? let me just ask miss zurface. what, you're a lawyer. you followed what happened in the supreme court last year. and a lot of the argument that was brought against the affordable care act was based upon the constitutionality of using the commerce clause to compel the purchase of health insurance. now had the individual mandate existed three years ago, would you have had health insurance? >> if the individual mandate had existed three years ago it would appear i would have been mandated to have insurance. so under, by nature, yes, i

would have to say i would have had insurance three years ago prior to the time i would have been diagnosed with this illness. >> except those things that were a barrier for you to purchase insurance three years ago would still have been a barrier? i mean the cost. you yourself point out how your income can fluctuate quite a bit during the year. one could even visualize a scenario where at one point you might be eligible for the ohio medicaid expansion and at 138% of federal poverty limit and at another point you get a lot of work you might be making too much money to qualify even for the subsidies in the exchange. and of course, as you know, people who then earn more income than would have allowed them to receive, you don't know going into a year what kind of year you're going to have, do you? >> not at all. >> as far as billing and collections. you may be eligible and receive the subsidy but what about at the end of the year

we may ask for the subsidy back because you had a good year. >> sure. >> so it is not quite as straightforward as just, yeah, the mandate had been there i probably would have had insurance. the barriers would have still existed i submit that, the very things that prevented you from purchasing that insurance three years ago will in fact still be there for people who are simply required to buy insurance and some will because, well, it is a the law, i got to do it. others will, no, it is still too expensive. still too much of a barrier. the fine is relatively modest, at least for several years. for single individual earning under a certain level at 6 or $700. yeah, if they catch me, then fine, i will pay the fine but otherwise, i can make a payment on a bass boat for what i can buy health insurance. a lot of people are simply elect to not to do that. i don't know if we changed it. mr. miller, you're bound to have thoughts on the concept

of whether the individual mandate will change the behavior of people who are looking at the insurance market and are kept out of it because of some of the barriers that have been discussed here today? >> well, cbo relied upon a small sample size of massachusetts basically to make its projections on coverage take-up. although they covered their tracks since then they were assuming people would be good americans obeying the law and the mandate is a command was a big factor in its projections of the take-up, not just the subsidies alone. they haven't really dialed back on what those assumptions are in terms of what would be the coverage from the mandate which is now just seen as a tax. and when you see things as a tax, other people who looked at this said, you will make a financial calculation. do i pay a small tax or do i pay a much higher premium particularly with premiums some individuals are going much higher than what it actually cost them in insurance. so there's a lot of skepticism as to how effective the weak mandate

as it currently exists both before and after the supreme court, what it will really mean in terms of pushing people into the coverage to pay much more than they ordinarily would pay. >> there is still the safety net of community rating and guaranteed issue. you can buy the insurance in emergency room or perhaps in the ambulance on your smartphone on the way to the hospital after the accident? >> correct. we have medicaid coverage which is provided after the fact. it has been going on for some time. you can sign them up in surgery actually. and certainly depends, all the regs are not there how to handle the guaranteed issued under the affordable care act, whether it will have a waiting period or enrollment period for couple months. let me just take a moment, because i know we're about to finish. i sit here, i like to stand in astonishment. ron means well and says a lot of nice things at the hearing. i read his report last summer for families usa in july of 2012. there was no nuance in that. it was a screaming headline. nearly 65 million americans at risk of losing their

coverage but for the affordable care act. not one word or sentence in there about all the protections for people with employer sponsored coverage. this problem of overshooting the mark and saying run for your lives, you're about to lose everything, hhs had a report in 2009, had over 125 million people at risk. we marked down to 65 million in ron's report. then we had another one by commonwealth, 12.5. when serious people look at this say where's the problem you get down to 4 or 5 million where it actually matters, people are not getting coverage. some case they may get a little bit of a rate-up in their premiums which accounts for that we ought to talk about where the problem is and what the dimensions are. it is serious enough problem without exaggerating it. we can deal with it in a forceful, effective way. but it is used to leverage a larger agenda to rope everybody into something else which we won't support because we want to scare people you're about to be at immediatistic when that is

overstated. it. >> i'm about to run out of time. in fact i am out of time. mr. chairman, if i could i would like to ask a question about dr. collins because the issue of cost has come up. of course we were tasked to fix were preexisting conditions, not messing up the system as it currently exists and third the cost and looks like we failed on all three points. with respect to cost, the commonwealth fund put out a paper from minnesota, that talks about the activated patient where the costs were lower for someone who actually was an active participant in their care and we had all the hearings leading up to the affordable care act and we heard from experts on medicaid, experts on this and experts on that, we never brought in say, governor mitch daniels from indiana, with the his healthy indiana plan,

creating that active patient population found he brought his costs down significantly over a two-year span. it seems like that would be a logical way to approach things. we're talking about states expanding medicaid. we're not talking about people who are already mandatory populations. that is people in nursing homes. people who are blind and disabled children. we're talking about new coverage for basically for young adults who are healthy. why wouldn't we use this activated patient model that the commonwealth found wrote about in incorporating that expansion? >> you know i think you raised a very good point and i think the discussion of cost earlier is really important. i think the viability of the affordable care act and coverage expansions over time will depend on the affordability of the premiums but half the law does address the you know lying cost drivers in the system through significant set of delivery system reforms. a lot of which have already gone into place. i think the law also encorns, unlike some of the --

encourages unlike some of the comments made huge innovation at state level. states have enormous flexibility designing their insurance exchanges if they want to do so. they also have primary responsibility for regulating their insurance markets, and delivery system reforms we're seeing a slowdown in health care costs over the last couple years. part of that is recession related but part of that is probably structural. we're seeing changes in the system both being driven by innovations like going on in ohio and indiana but also some that are being driven by incentives and new grants, grant funding provided under the affordable care act. this is hugely important problem for the united states. it will determine the viability of the coverage provisions over time. there are insurance market regulations that do address premium growth. we've already seen a huge decline in the number of premium rate increase requests from insurance companies because of the rate review program that has been in effect for the last year.

medical loss ratio requirement will have also having a huge impact. $1.5 million in rebates and administrative cost savings last year just as a result of that provision alone. so the affordable care act is not just about coverage. in fact over its 10-year budget projection it actually resueses, reduces the overall deficit because of these additional differry system reforms in addition to the coverage requirements. >> you know, governor daniels said in a piece in the "wall street journal" several years ago now, even before while we were still debating the affordable care act, by providing state employees with high deductible policy for catastrophic coverage and then providing them the funds to pay that high deductible should they be required to do so, allowing them to keep the money in those health savings accounts if they didn't spend it, he came to the conclusion that something magic happens when people spend their own money for health care, even if it wasn't their own money in

the first place and i don't know why there has been such a resistance to accepting that lesson that he has shown so elegantly in indiana and why we won't allow it to occur in more places. lieutenant governor, i give you the last word. i rather suspect the flexibility that dr. collins spoke about is something that you would welcome, is that not correct? >> mr. chairman, dr. burgess, yes, and i guess my comment with regard to all of the flexibility that has portended to be given to the states both in how exchanges are organized, if you read the rules and regulations look at least ohio's history with dealing with high-risk pool, my definition of flexibility as it relates to dealing with hhs and cms is, you can have as much flexibility as you want as long as you do it my way and unfortunately for ohio, we have the experience that we have had little flexibility and if there was as much flexibility as is being

suggested, i think you would have less concerns or issues coming from individual state regulators who say, you tell us we can regulate our market but when you disagree with what we have conclude as with the high-risk pool and whether or not individual consumers were eligible for coverage, it was up to us until you decided no. and that is unfortunately the experience that we have had. >> thank you, mr. chairman. my time's expired. i yield back. >> chair thanks the gentleman. we have other questions but we'll ask them the members to submit their for the record and ask the witnesses to respond promptly. when you receive those questions, this has been an excellent hearing. very, very important issue. and, i want to thank the witnesses for taking time to come and present their testimony. i remind the members they should submit their questions by the close of business on wednesday, april

17th. so, without objection, with thanks to the witnesses this subcommittee is adjourned. [inaudible conversations] >> all this week on c-span2, booktv in prime time. tonight reporting on

historical events. at 8:00 eastern, this is the day and photo journalism of leonard freid that captured the 1963 march on washington. editor of scoop recounts the light of her late husband, jack nelson, a reporter for the "atlanta constitution" and "the los angeles times". and at 9:45, todd anorik. his book, reporting the revolutionary war. booktv in prime time this week here on c-span2. president obama talks this afternoon about measures to reduce gun violence. he will speak in denver after colorado recently approved gun control measures. you can see the president's comments live at 5:00 p.m. eastern over on c-span. at 7:00 eastern tonight on c-span, our q&a conversation with codepink cofounder, media benjamin. after the interview at 8:00

we want to hear what you think about the group's mission and tactics and how protest movements fit into the discussion in the u.s. recently codepink protested at confirmation hearing for then cia director nominee, john brennan. >> very pleased to be joined by my wife kathy and my brother tom. >> i speak for the mothers and children -- >> we will stop again. all right. >> in pakistan, somalia and who else, and where else. >> please remove that woman. >> the obama administration refuse to even tell congress. they won't even tell congress what countries we are killing children in. >> please. >> senator feinstein -- >> please expedite the removal. >> what is more important than the children of pakistan and yemen? what could be more important? do your jobs. world peace depends on it. making more enemies. >> please proceed.

>> [inaudible]. >> all right. i'm going to, we're going to halt the hearing. i'm going to ask the that the room be cleared and that the codepink associates not be permitted to come back in. done this five times now. and five times are enough. >> american people --. >> codepink protests from john brennan's cia confirmation hearing recaller this year. tonight at 8:00 eastern, come in and share your stop about codepink and other protest movements all around the country. you can join in the discussion right now at our facebook page. facebook.com/cspan. >> so she was out there in a way that, as i indicated before, respectable women did not do. this is a new era

this is a time the woman's movement is underway. someone like julia tyler fits into an extent. she is very conservative in some ways but in terms of breaking through the traditional way a woman should behave. she is doing it, in a way other women are not at this time. >> conversation with historians on julia tyler, second wife of president john tyler is available on our website. c spon.org/first ladies. >> a hearing on editorial cartoons. you ever university of rochester professor, theodore brown talked about policies were displayed during the early 20th century. the creation of medicare in the 1960s and during the debate over the 2010 health care law. hosted by the roosevelt house in new york, this discussion from february is just over an hour.

>> good evening, everyone. i also want to take the opportunity to welcome you here to roosevelt house. i want to thank a couple people verily quickly. obviously president jennifer rabb. who is extraordinarily supportive of the fellowship and program here at roosevelt house. dr. rabb. couldn't be with us tonight. i want to thank her for her hard work and support. and laura tish and rick from the tish i will loom naics fund who fund the fellowship and program here. it is an important addition to the new york community. this really, this house has really served as a wonderful place for intellectual discussion, debate around a whole range of social policy issues and, we're really excited they could be here

with us tonight for that. you heard a lot about this house and i just got to tell you that, you know, when you're at home and i consider this home and you get up at 3:00 in the morning, and you walk down to the third floor of, outside the second floor, and you sit there at, 3:00 in the morning and you realize this is the place where fdr conceived the social safety net, and you're a progressive, i got to tell you, it just, it really makes you feel warm. and you know, at that time, of course the affordable care act was in the stage of being implemented, just being implemented. and as you know many of us were concerned that people really didn't understand what they were getting. they didn't really understand what they needed, what they were getting. a lot of misinformation. but what i was even more fascinated with despite the clinton health care reform debate many years before was the number of people who thought this was kind of a

new idea. that this was something fresh and really were not chrud in on the long history of health reform. now i'm a visual learner. and a fan of political cartoons. and as i thought about them, doing the health reform debate there were lots of cartoons flying around. just listening to them every day and read them and just laugh, just about every day when they would come out and as i thought about my project, it seemed to me this would be a great way to tell the story of health reform. of course decided let's do it over 100 years. this is not just about obamacare. this is about the whole 100 year history of health reform. so i kicked the idea around with folks like dr. jonathan stanton, who is the fdr visiting fellow and runs the overall the program here and many of the senior staff who are also fans of political cartoons and those folks, you know, kind of thought it was a good idea. you know, i had cartoons

where i could show them and give them an idea what this might look like. they helped me identify our research assistants who aided in cataloging of the cartoons and ultimately did a lot more work on the book and ended up being a coauthor as well. she is with us here today. i also thought about who might help me with the history of this project. and of course i thought about immediately my good colleague, ted brown, who's very active member of the american public health association and the american journal of public health editorial board and i knew that ted had a history of telling the story of health reform, particularly in the early days using political cartoons and of course he is an absolutely a major contributor to this work. we could not have done this without ted, i can tell you. also ted, you know, my understand was -- idea was to take cartoons and put them out in chronological order and maybe tell a little annotation after each cartoon just so that people

would understand what they would like 10 years before and so we go back 10 years later you look at the cartoons, say okay, that was the context of the cartoons was all about but ted said, no, no, what we need to do is tell a story and we need to be storytellers here. so we added the cartoons, ted's narrative. we thought about some of the cartoons we were doing and really a way to tell this story and, you know that coupled with, you know, talking to other people who were doing books that were kind of similar to this. marion nestle i know is here. she is doing a text on health and nutrition i believe using political cartoons. so i talked to marion about some of her experiences doing this kind of book. like everything else in public health this was a group project. and marian helped us link with the cartoonist group.

the founder, sara there was quite intrigued with the idea. so they partnered with us and really applied, supplied most of the cartoons in the later part of the book. i can tell you this book has about 174 pages packed with cartoons, some images in the early part of the book with over 27 cartoonists. by the way, nine of them at least have won the pulitzer prize. so that was amazing to get those, that kind of talent in this kind of book. of course you're going to hear from one of these amazing cartoonists a little later in the present takes, clay bennett in, who did the forward for the book. now clay draws for the "chattanooga times free press" and himself was a winner of the 2002 pulitzer prize for editorial cartooning. again, clay, thank you very much for the work that

you've done on this book. so with that in mind and that introduction i want to bring up our first speaker which is dr. ted brown. and ted's going to talk to us about the history of health reform. ted. >> well, thank you for coming this evening and i'm looking forward to trying to tell some of this history in a very quick overview because obviously it's so rich and so painful at the same time that we can only get some glimpses of it. what i would like to illustrate there is an important historical arc that the political cartoons will be showing can be used for as sources. they're historical sources in context that tell part of

the story and that anchor part of the story. and you can see by the way the cartoons will flow by that there are recurring themes as well as novel difficulties and challenges that arise at certain times. so let's start with this one which is the oldest historical cartoon i am aware of, 1910, that talks directly about the health reform issue. put out by something called the american association of labor association, talking about workman's compensation, health reform. the meaning of the cartoon is clear. the english worker is much better protected with the american with the skimpy umbrella and we should learn from our english compatriots so the american worker who is shoaf venice i canly naturally taller and more robust is not beaten down by the elements because of lack of protection. health reform did quite well in this period from the late 1900s to the late 1910s but

it ran into major problems. the major problem was the first red scare that came in the wake of the refresh your recollection shun revolution. there were other challenges. special interest groups. commercial insurance industry, the rank-and-file of the american medical association, all which contributed to this. as you will hear soon they obama the familiar suspects. but the red scare really changed everything because now there was a ready label to condemn the efforts creating uniform national health program and that was it was socialized medicine. it was bowl shavoicic and that label has been attached to it almost ever since. by the 1920s and '30s there was clear division in the medical profession. there was left-wing and right-wing and at least a liberal faction and more conservative faction. here they are in the combat in the 1930s what would be a proposal health care reform introduced by senator robert wagner, liberal democratic

senator from new york, so important in the new deal and so important in health reform. am i not projecting? usually i have to watch out i don't blow people out of the back of the room. i have a natural tendency without microphones to project. this cartoon is joined by herbert block, who had a career of more than 50 years drawing cartoons about issues and moments in the health reform debate. what is wonderful, if you do a little historical research on this cartoon, both figures there are actually caricatures of real persons central in this battle. on the right, that is isaac max rubineau and on the left is formidable, morris fishbein, editor of "jama", the journal of the american medical association. and most outly effective antagonist of health reform who coined some of the worst phrases to characterize it. we fast forward to the 1940s in an era which you hurd

truman promoting health reform, endorsing bills introduced by senator wagner and his cosponsors. now even more dangerous version of red scare. in the late '40s when we have mccarthyism and we have the international cold war. so of course opponents to health reform have, and truman's program used the images of the cold war to try to discount and discredit what president truman and legislative allies are trying to do. there is uncle sam son i will call him. you know what happens to sampson when his locks will be shorn. his locks will be shorn if he doesn't wake up by the shears labeled clearly, socialized medicine. the person holding it on his sleeve the communist hammer and sickle of the soviet union. he is napping not realizing the headlines in the paper, in his lap, russia's aim is destroy america with vehicle of national health reform as

a device to do that and disintegrate the fabric of the country. as a result of that, i'm going to combine a number of things in this one slide. the united states movement in the direction of some kind of national health coverage but it was a very bizarre kind, international unique, kind, coverage through employment through collectively bargained arrangements provided by commercial insurance agencies. the wind was taken out of the sales of national health program of some kind of a uniform program, universal program that would be implemented with government playing a critical role. instead lots and lots of people got health insurance through employment which was great for employees and their families and terrible when those employees retired because now they faced increasing challenges of health care in their latter years at the same time they have less means and had no health insurance which no one was willing to pick up. this became the moment in the 1950s when some very bright reform-minded person came up with the idea of

medicare. we can't get universal health insurance through in this political climate. that will run into all the old weapons that have been used against us but maybe if we tug on people's heartstrings and point out to them the objective needs of the elderly we can get uniform health care for over 65 who qualify for social security retirement and maybe then widen it out. here is that very ominous threat that politicians and others have to fear because the elderly we all know is the best organized most likely to vote cohort in the population and they use their political weight. in the 1960s, battles over medicare raged similar to battles that had been raging before. and the familiar suspects were lined up. left, right, center. the american medical association was still playing extremely negative role. the commercial insurance industry. conservative politicians, right-wing groups and so on. on the other side various progressive organizations

but there was a new element in all this and that new element was leaders of the civil rights movement and in the naacp and national medical association of african-american physicians knew that hospitals and other health care institutions were incredibly badly segregated and they saw the medicare problem as a possible implement for forcing the desegregation, integration of hospitals knowing that hospitals would be desperate for these fund and if they put pressure on administration, which they were able to do, when lyndon johnson became president after kennedy's sass national -- assassination, they would have a ready ally in the administration to hold out as carrot and stick medicare funds to force the integration of hospitals. this was a very important new political element. that plus the general climate of the '60s probably tipped the balance in favor of medicare, a universal form of health insurance but for an age cohort that made

it unique in the world where there were now many universal systems but none structured this way. those who wanted to go further saw this was the starting point and became proponents of a universallized version of medicare, medicare for all, single-payer. and by the '70s, this is also fast forward several years, there were leaders like teddy kennedy, reflected there in what would have been the mirror of jimmy carter's cabinet, pushing very hard for health reform for universal programs, which proliferated during the '70s. there was by the mid '70s even a program sponsored by the american medical association after its own rights. there had been a few years before one sponsored by richard nixon. so the question was now whether we would get universal health reform but whether we would get a particular kind of it such as kennedy was advocating. then the bottom fell out. there was a major economic crisis in the 1970s.

stagflation, the oil embargo and now the worry was not extending coverage to everyone, making it accessible but can we afford it because health care is wildly inflationary, far outpacing inflation in general and at that time, how could we imagine incurring more costs at that moment? carter began as a lukewarm supporter of health, international -- national health insurance. by the mid definitely his administration he began to slow down and oppose it. by the end of the administration, kennedy was opposing him, challenging him for the nomination and so on. this of course is a parody of a famous ad that ran on television these days where someone looks in the mirror and another face comes back, what could be more who are risk for jimmy carter to have teddy kennedy looking back from his bathroom mirror. we move forward or backward into the reagan era. there you can see why national health reform didn't do very well during the 1980s. that was reagan's mantra. that meant that he would not

support any kind of universal program. in fact as we all know he tried to cut the safety net. he cut medicaid. he cut food stamp programs. he tried to cut medicare. there was important pushback. he couldn't away with that but he implemented new funding mechanisms, oddly originally invented during the carter administration but implemented during the reagan years for perspective payment by drgs. that meant a very important dynamic set in of cost shifting so that those who were covered by health insurance in a robust form through employment now had to take a much heavier burden to make up for the lesser revenues coming from medicare because of prospective payment program. that meant health care premiums began to shoot through the roof. employers were beginning to push back cost on to employees as they dig more deeply into the pockets for co-payments and coinsurance. it also combination of things forced a lot of people out of insurance and

so we had soon a dual problem. which was the problem of the covered and the problem of the uncovered. by that time, this is another herb block cartoon. he had been cartooning about health issues for 53 years by my county point and every year in between. 33 million uninsured. now the number is closer to 50 million. those were covered supposedly were covered in burdensome way, heavy administrative burden and increasing costs. this was not a good situation. it made health reform an issue for the middle class and not just for those who were more vulnerable and at the bottom of the political spectrum. it led to the clinton deciding that health reform was a major issue and he ran on this as one of the prime campaign planks in his platform. got elected, we all know. had great ambitions for health reform. commission was established. hillary was the face for the commission. the commission ran into

trouble. safe to say, clinton's health reform for reasons we can analyze in many books about this was a colossal failure. a lot fell on hillary unfairly. this cartoon, brilliant cartoon by nick anderson, with credit due to mc -- it is visual parody with bizarre surreal planes you can't move from one level to another. as i look at it, as we say in the book, images of hillary trying to find her way through the tangle of health reform, trying to pursue staircases to nowhere. after this failure there were some attempts in the latter years of the clinton administration to do important piecemeal reforms. not so piecemeal. actually rather important like schip for example in the late 1990s but not universal reform. george w. bush of course had other things on his plate. we don't have to go into those now but some cynics

point out that he suddenly got interested in medicare reform towards the end much his first term, thinking of it as a possible election issue and came up with what everyone who looks at it closely regards as a very bizarre form of medicare reform, the medicare modernization act of 2003 which in many ways is a huge give away to big pharma and so on. it creates medicare part-d with strange gaping doughnut hole. that was what he did. so, there wasn't at the national level any return to clinton's aspirations until the 2008 election. candidate mccain really reinvented or warmed up again an old republican idea of giving people tax credits while changing nothing else. and this is a matt worker cartoon. matt is another favorite. he is the most recent recipient of the pulitzer prize in political

cartooning. got it in 2012. there is mccain into lifeline in the arm being sucked dry by leeches labeled insurance industry, farm that and -- pharma, and hmos. that is workers perspective and reasonably analytically accurate perspective. but barack obama backed into health reform too. it wasn't one of his strong suits. he was outdistanced earlier in his primary campaigns by hillary of course with great expertise and even by john edwards. so he had to catch up. by the time he was elected and had two chief advisors, david axelrod and rahm emanuel, beautiful character atures standing next to him he is acting academically and talking about end abouting down of cost curve. the conversation is, how is the message war going? what? can't hear you because that messaging is being drowned out by ominous looking machine in the back, the great noise machine ranting from its loud speakers from talk radio and other places,

fox news. commies, confusion, socialism, kill granny and so on which are some familiar and some new threatening phrases and language that have been used time and again to try to stop the road to reform. barack obama created some of his own problems. this is a very cynical cartoon about barack obama. he obviously looks like neville chamberlain in 1938. that is munich a piecement. he is gaving away czechoslovakia. little-known he has to declare because he invaded poland nonetheless. this appeasement to the republicans. and the major form of appeasement takes the shape of the individual mandate which had been a republican idea when it was invented by the heritage foundation, a right-wing think tank in 1989 and maintained by the republicans through 2006

when it became the basis for massachusetts reform under governor romney, though he seems to have amnesia about that. and also incorporating the commercial insurance industry and big pharma in central roles. this is anything but single payer. anything but medicare for all. and the hope is, that by moving in this direction, by allowing the market and commercial interests to play such a large role he will please the republicans. he will appease them and they will support his efforts. of course none of this happened. as it didn't happen as chamberlain wanted in 1938. he had other problems. our guest clay bennett is the author, artist created this cartoon. part of the problem is that the democrats themselves were not acrobat i canly too fine. they didn't coordinate their activities. instead some wonderful pass-off they were inept and awkward and relations between the house and the senate were particularly difficult, it looks like

harry reid is not going to catch that health reform victim. and this is also the democrats did a lot of damage to themselves by their failure to play the political game as it may needed to have been played. and the end result is this. that's what some people think of the health reform, of the affordable care act. there are wonderful things in it but mostly it carries over our existing, bloated, ineffective and profit-driven health care system with a little bit of cosmetic change but you know the expression. you can put lipstick on a pig, well you can complete that. which is what the message is here. that is not the only problem. of course the president had to face the challenges of the courts. these began as political challenges by states attorney general and 26 states joined together to create one lawsuit that was then brought to the supreme court.

it's a very peculiar supreme court as we all know and it was very unclear how it would go. the very jittery moments, the obama administration had a proud face and seemed to, used confidence in public but in reality, a lot of nervousness that the court would do exactly that, that is, hammer away at the foundations just as they were being constructed. the outcome as we all know is very surprising. this is another wonderful cartoon, and here you see the four liberal judges, look with justice roberts, who did not, he voted with the conservative majority, saying that the interstate commerce clause defense that the obama administration argued would not hold but then turned around and said, we can't hold this on the basis of the tax provisions constitution. because if you don't buy health insurance you have a penalty and penalty is tax. therefore, et cetera it is somewhat interesting and circuitous reasoning. president obama is looking on with some curiosity and,

i guess, view would be sar donic. how did this pass, how did this happen? this is exactly the unpredictable outcome but it was an outcome which upheld the affordable care act. there is another decision made by the supreme court at the same time, this decision was released in late june of this past summer. a very important provision. the obama administration wants to extend health insurance, health coverage to something like 20 to 30 million people by making those up to 133% of poverty eligible for extended medicaid. and providing federal fund to do most of the work for the states for the first years and then even in continue ages. but the obama administration had written into the affordable care act if the state didn't agree to do that there would be certain kinds of penalties. argument against this it was too coercive. and another decision which came down 7-2, with even justices breyer and kagan

going over to the conservative side and only sotomayor and ginsberg holding out as the two minority, saying that that would be too coercive and too punitive. so states, if they want could choose to accept the fund but they didn't have to, which, suddenly threw open the possibility that many states, which is now the case will resist extending medicaid, even if it is in their financial interest. more a question of ideology and opposition than it was positive, concrete benefit for their citizens. so the real policy states, in my last cartoon, this one which is the most recent in our book, came out in july, 2012, by nick anderson. that is the real policy of the red states. dumping the patients who should have been, would have been, are under possibility of being covered by the affordable care act under medicare extension instead, dumping them at the door of the emergency room which will have reunder boing and

cascading effects negatively on the whole health financing arrangements and on all of us. it's a very poor policy. thank you. [applause] >> all right. so i want to warn you all that the iq level is about to plummet. let me, i need some assistance here. i'm guessing. it is a pc. what can i say. . .

i and every other cartoonist would like to think that we hold some profoundly affect of society to be quite frank i think the jury is still out on that. i do know that if popular opinion or election results are any indication that my own

effect is questionable at best. so instead of trying to on prove the unprovable i will talk about how editorial cartoonists try to affect the public discourse. better yet since i can't really speak for anyone but myself, i'm going to limit my remarks when i see my role as an editorial cartoonist. i'm not on the art form in general but i am the world's foremost authority. this event is all about health care in america. i will be sharing cartoons on a range of issues to reassure i

could show you -- you are slowing me down. [laughter] i could show you work on my health care reform was needed in the first place. i can even show cartoons about the obstacles and impediments in getting their reform passed. and i could follow those with more about the threats of repealed after it is passed but i won't do any of that. what i will do is show cartoons on many different topics to explain what motivates me as an editorial cartoonist and what relative and that my work seems to have over the years.

if you want to look at cartoons about health care reform, by the book. as i read fair and impartial journalism will always have a special place in my heart, just not in my work and how could it? the very job description of a cartoonist is to present an opinion on a political issue or current event and to express that using humor, ridicule, exaggeration and mockery. [laughter] your laughing at dead people bobbing in a pool and. they're not supposed to be even-handed or impartial, they are not supposed to be fair

which is fortunate for me because i am none of those things. i have been drawing cartoons -- [laughter] i've been drawing cartoons for the free press a little over five years now. but i've been in the business for over three decades. although it hasn't been a particularly great 30 years for the country, it has been a great time to be an editorial cartoonist. over that time -- [laughter] and yes, there are eight cans. you don't need to count my attention to detail. i've been able to force my opinions on the undeserving readers of six different newspapers in five different states. before moving to tennessee i

worked for newspapers in pennsylvania, north carolina, to peepers and florida and for a decade and served as a staff cartoonist for the christian science monitor in boston. with a publication like the monitor i concentrated exclusively on the national and international issues. it was a great job so a lot of my friends and colleagues were surprised when i left and more than a few wondered why i would want to move from a liberal city like boston to a conservative states like tennessee but i had my reasons for making the move. growing up in alabama i've always been a southern boy at heart and even though i couldn't find a bus fast enough to get me out of the south when i was 21-years-old, later in life i started to have a strange yearning to return to the region

that have left such a lasting scar on my psyche. this is the irony of passing in english only law in tennessee. editorial cartooning is an - art form. it's based on the sand and fuelled by a cartoonist discontent and elimination. so, it was a really difficult for someone like me to work up a righteous indignation in a city like boston where politicians are so progressive and public policy is so enlightened. let me tell you, tennessee has been a welcome relief from all of that. i found nothing lightens the mood like a little hop lethal injection humor.

dead people bobbing in paul's, lethal injection, okay i'm figuring this crowd out. but see now that i'm living in tennessee, it's a constant state of indignation. in fact i am so discontent and so alienated, i just don't know how i could be any happier. [laughter] i knew it was going to be a great move, but i really had no kind of idea what cartooning goldgeier would strike in tennessee. now look i just included this cartoon because it has more legal than any other cartoon in my life and a little cartooning and fais, you have gone one label too far but i digress. true blue progress of flushing and one of the rest of all of the red states, tennessee, the

place a man as measured by the caliber of his handgun and a woman as measured by commonwealth the caliber of her hand gun. tennessee is a state that convicted a man for teaching evolution 87 years ago. [laughter] and the same state that just this past year enacted a law that allows the teaching of a biblical alternative to darwinism. so much for evolution i guess. you have to love a state that has major industrial interest like coal mining for instance. we have nuclear power is really big. no flights were killed in the production of this cartoon. and more recently, the hydraulic

fracturing of oil and gas. this is one i've done in the last week in fact i drew this cartoon on fracking. you know, i felt the of their day i feel sorry for the industry because of their name. fracking. these guys it's really incumbent on them to come up with a new name. if you could have been a focus group and come up with a more in barras and naim i don't think you could have done it. so i think these frackers need to change their name. i was thinking the other day how about gassoles? [laughter] it's just an idea. kind of an idea problem solver. and of course we have a state legislature in national that seems more than willing to do the bidding of all of these industries.

there's the general assembly. [laughter] now that is the sexiest woman i've ever drawn. i've got to tell you which isn't setting the bar high. of course in tennessee like the rest of the self religion permeates every aspect of life. even our chicken sandwiches. for northern, that is the chick-fil-a logo. i think that you can see why i am so taken with chattanooga but he might be wondering how chattanooga has taken to me. i haven't been at the paper all that long but i think the readers are starting to warm up to me. but that's only if your definition includes the words loafing and contempt. even though they may not pay me a lot of respect, if my eight

male is any indication at least they are paying attention. succumb i will show you what i mean. i brought some finals here. i brought this file of hate mail this is from the last several months. it's a bunch of cards and letters from people ranging from those that really hate me to those that really hit me. my favorites are the ones they clap my cartoons out of the paper and school a message or messages all over. now it's kind of a unabomber i admit. but i suppose it does save them money on stationery and i dig the fact that they are in recycling. so i've actually included a couple of these particular types

of cartoons in my slide show i want to share. here's the first one. so, let's take a look at this one. this reader certainly has a laundry list of complaints. he claims i lacks style or good taste and i'm distasteful and offensive, which is fine and a really hard to debate. but it's when he calls me a red neck. now listen i've been at this for 30 years. i've been called fred many times but a red neck i think that is on called for. here's another one. this one left a little less diplomatic than the first. he goes right for the big guns calling me a baby killer and antichrist. i don't know if it is the antichrist or if i am just antichrist. i kind of hope it was the antichrist.

you have to have goals in life. but anyway, that's fine. i'm fine with baby killer and antichrist, just don't call me a red neck. so, these cartoons, i get them all the time, they don't always contain such a leverett messages. sometimes they are really simple like this next one where a reader simply scrolled bullshit on my cartoon. i'm sorry. i find this one just a little bit embarrassing because bullshit is one word. [laughter] now i don't want you to -- i don't want you to think that it's all about heat in chattanooga. i do get fan letters. i brought my file of fan letters. [laughter] well, a letter, sort of a

postcard. but i don't know. is your not as stupid as you look a positive comment? i'm thinking yes by setting the bar kind of low. this brings me to the story of my favorite letter of all time it's of the cartoon variety the dramatization of actual events and this is neither of a cartoon or the reader that was involved in this incident. i will tell you that. but, let me see year. some time ago a reader clipped one of my cartoons out of the newspaper, which as you have already seen is hardly unusual. now, what was unusual is what he did next. their leader took the cartooning and proceeded to use it in a way that someone customarily uses paper in a restroom.

once the mission must complete, he slept the cartoon into an envelope mailed back to me complete with a sample of his dna. you talk about putting ground back in disgruntled. let's face it, you can't do that with an e-mail. [laughter] can you? i know it's kind of gross. okay, it's really gross but you have to give him points for originality and especially for commitment. as a cartoonist, i particularly admired his ability to express a strong opinion without using any words. but look, say what you will. this is just the kind of sophisticated political dialogue that brought me back to the south. i love my readers.

even those who don't seem to love me. especially the ones that don't seem to love me. as an editorial cartoonist all you can do is promote a vigorous debate on the issues of today. i am proud to report that the debate in chattanooga is quite vigorous, so vigorous in fact that at times it borders on menacing. but even though my wife might be concerned when the occasional death threat comes my way, i can only see it as the greatest compliment the cartoonist can receive. so, as i wrap things up, i would like to apologize to anyone who took umbrage any conservatives and the audience who took offense to anything i said or any of the curtains i've shown i would say no offense was intended but that wouldn't be true. some offense was intended and so

long in my apology i have a peace offering for those that i offended. i thought i would and my presentation with something even the conservatives might appreciate. it's a cute puppy. didn't that make it all okay? thank you very much. [applause] >> i hope the book is as funny. but me ask you one question and then go to the audience. are there questions in the audience first?

>> you've been telling this story on health reform for some time. what did you leave out? >> nothing of course. this is a very selective presentation. what you have to do is remove a lot of the details and the nuance and try to get to the major themes a reader that is not familiar with the subject can grasp and then we've that around an image so there are levels of complexities and subtleties that couldn't be captured in the limited space we had. wanted to say things the rn cube and distilled that will be the basis of substantial reading and then if people wanted to go further and get the nuance story we suggest reading in the back of the books we have a list of giglio graphic agenda where people can go and read political scientists continuing on these issues. i don't think that we have distorted any of the big themes or moments in the development

but we haven't presented enough players and complexities. >> you left out a lot of my cartoons. [laughter] >> i knew of at least ten more that i would have liked to see. >> we were under strict limits. >> what do you think are some of the topics that might be thought of this year? >> i was talking earlier to a friend about the liberal politics and about how discouraging the changes are and i think this debate shows it took 100 years to get health care and as they all say the art of history has been towards

justice and in my lifetime that is just a gay rights as an issue. 30 years ago when i was in college, most everybody was still closeted and now it is to the level the marriage is an inevitability and is being added to the civil rights bill for work protectionism and it's just a matter of when it's going to happen and not if it's going to happen. and i do believe as naive as i may be that even this supreme court will rule in favor of the right side on both of the cases that are heading towards this issue. the mayor rejected history. i think it is going to go in history and proposition 8 will do the same. it just depends on how much the court wants to say on the case. and you've got to think if they

took this case on they could only think of one or two things. either they think they can overturn the court's or they can use it as the foundation for a broad ruling in volume one that hopes they are thinking of the latter. that's what i'm looking for this year, monumental things. >> what you think the next steps are in health reform? >> i have a different perspective. i guess i'm occupationally cynical. and i am worried about the way in which the affordable care act for all of the achievements have been will begin to fall apart and well create major problems. what i foresee and there are indications of this along the way part of what the affordable care act is to accomplish is a minimization of increments in premiums from year to year in fact they continue in many places with a double digit inflation. we are supposed to also benefit

from moving to the electronic medical records which will make things more streamlined. the evidence is electronic medical records come expenses go up, medicare costs are inflating as medical records go minute. i am very worried about this medicaid expansion. so, what i see is that in the near future of the next year or two that many of the folks in the affordable care act might not be realized in practice and they may need to really rethink that. i will confess full disclosure. i met strong advocate of single-payer medicare for all and i don't think would be a terrible outcome if some of these things did happen negatively so people can get it right now finally and given the single-payer direction. [applause] >> your thoughts on single-payer >> i think that obamacare, which and glad he finally embraced that because it is so easy to say, wasn't nearly radical

enough. i am also a fan of single-payer and medicare for all. i'm not as cynical because i think it may be to the detriment of those that stand in the way of the medicaid expansion pivot i've already seen in my own state and tennessee where the legislature is steadfast against these expansions that the governor is already starting to sweat it out because he understands that this 100% covered for three years and 90% every year after that and we are talking about 200,000 that would be added to the coverage of the medicaid system. those are people's lives the state could be positively affecting. so i'm hoping that the pressure is applied to the right side. islamic their fincen reports that there is shuttling in the ranks and some people with as an elective health care commissioner and the elected

governor for both republicans they disagree with one another and one is more illogical and one is more pragmatic because the bottom line is so overwhelming so that is the case may be abandoned my cynicism temporarily. >> you will be looking over the state lines and seeing your relatives or friends getting more benefits because their state interested in your state didn't. i'm hoping that sort of correct apples to apples comparison will lead to the right decision. >> i don't think you have to abandon or cynicism. they will end up going for it because the hospital lobby month because they care about to hundred thousand patients. in ohio yesterday he has an ideological as they come for the medicaid expansion. i question however have you come

up with a cartoon yet or is it in the cerebral stage about al gore salem current tv? >> i probably should do that. i look for any opportunity icahn to slam liberals because it kind of gives the illusion of objectivity. [laughter] i haven't been rushing to the drawing board on that issue and must admit to the and al gore was very prominent. but i don't know yet. i'm a big fan of al jazeera. i'm sorry. they are a really good news outlet. >> [inaudible] >> i don't know. i don't know if anybody works for al jazeera as a cartoonist. they could contact my syndicate and i would be glad to tell

them. >> our first fellow, john mcdonough that have your word was very much involved in trying to promote the affordable care act and in this very auditorium, he argued that if we looked very carefully at the national security act when it was first passed we would have been opposed to it as well and that getting this started as what was so important and that we would have amendments soon and i was wondering if you might comment on that perspective. >> during the d date when the republicans were talking about repealing obamacare did you notice it was always the caveat all the things that have come into play, the 26-year-old still being on your insurance policy, the no caps if, all the stuff

that's gone against it they've always said we will replicate all that stuff so all the stuff that's coming to be is very popular and i think like medicare the program will become increasingly popular than what benefits people in their lives. >> there is a poll that supports that. when people are asked about specific print provisions like covering age 26, 74 to 75% were in favor and then the rest would you think of obamacare and 55% were negative. there is a split in people's understanding that my view is not as optimistic about the reform i think we have to seize the moment and take advantage when there is a convergence of the political force to go for

the big enchilada and not a small piece of it because i don't think you can amend your way from the affordable care act to something that is much better. my sense of the dynamic is many of the cost cutting provisions or those which are trying to prevent the region's continuing inflation are not going to work is my prediction. when the burden of that when it becomes clear our system is still unsustainable then we are going to have to think about a system that is more coherently come more efficiently and fairly organized and that is when we will begin to move in the direction of the single payer system. >> i wondered what your thoughts were on the possibility of raising the medicare age. >> the challenges that while

that might sound good it leaves more seniors uncovered. so you still would have to find out some way to fill that hole and many people talked about lowering the age typically those that might retire earlier where there are significant others have become not covered because the other person retired early in the they are not yet eligible for medicare that's one of the challenges. the editing is a cost shift which is one of the biggest problems is the fact we are playing hot potato so we may very well save money on the federal but it will cost the whole system more because those people get moved from a relatively efficient both medically and a cost perspective

program medicare into a system that is much more expensive. >> i have two comments. one instead of raising the medicare eligible age, why not move to cap on medicare contributions so that you pay as long as you earn. >> that is a great idea and they are the same for social security you do pay medicare as long as you learn you are not paying social security. >> that's what i would change about social security you continue to take out the social security tax. >> the other comment is do you think that the effort of

characters going to cause the lower end of the economic spectrum the people in the 49% and below will start rallying around and become a voting bloc the way seniors have to protect the medicare? >> i think that's quite possible and why they fear that. the fact is i have the chance to be state health officials twice and many of the costs that were not factored into the cost savings with the affordable care act of all of the public health programs spending 100% state dollars for the silo the events of mental health, substance abuse, primary care. so those folks can now be put into the medicaid program whose incomes are below 133% of the federal poverty level and in a sense they would pick up 100% of the cost depending how the programs are structured. so, the savings in the states

are doing the calculations and beginning to realize there is money to be found in those programs as they bring those people and to full coverage. medicaid of course also provides a more comprehensive package for many people than some of the private insurance plans. and i would always argued that the best way to bring down medicare costs or to make sure people are welcoming into the medicare program to do that of course is to cover everyone from birth until the end of the medicare program. >> i have a slightly different spin on that. one of the most important books that has tried to analyze how the health system has resisted reform is a book by paul starr published in 2011 at the university press. he invented the term called protect the public so one of the major impediments to reform are those people that are covered

under their employers provide insurance or under medicare and don't want anything to change. why? i don't think your scenario can play on the 49% like the medicare population is because the affordable care act isn't any one thing. it is a set of things so if you are covered under your employer, if you are covered under buying into insurance in the new health care exchanges created the state level, another set of consumers with a different set of interest. if you are those covered by medicaid you are still on another set and so on. say you cannot imagine a uniform population rising under the one banner and defending the affordable care act because in fact the affordable care act is many different things under one umbrella. >> of the 49% won't rise up because if you are thinking for the 49 north 47% or whatever referred to as the people who don't pay any income tax because

a lot of those people don't even realize that they are part of that group. they held a tea party. is it really in their economic interest, is that any person's best and economic interest let's just be greedy. if middle class americans looked at objectively those platforms, it would be in their own best economic interest to stay clear of the republicans, but they don't. in tennessee they still elect a majority. and obama is elected nationally, tennessee is electing a supermajority in their state house and senate. so the democrats don't even have to show up. if the democrats want to walk a lot of the state it doesn't matter.

the republicans can still boosted business without it's crazy. >> are you more optimistic when you look at the state of vermont? >> it's the organization of great significance but the state that seems to be moving towards single-payer very clearly on the state level and pass a legislation with a strong majority in both houses of the legislature supported by the reform they brought in a world clause economist who analyzed and presented a specific plan now looks as if vermont may be on the way the problem is before vermont can even move in that direction they have to have wafers in the federal government. the affordable care act says you can't get a waiver until 2013.

and a part of the senator bernie sanders is trying to urge is that there would be moved up to 2014 because in the meantime, we know that on the ground, their representatives at the commercial insurance industry which creates confusion and distortion the longer they have to spread the particular propaganda, the more it will be taken out of the single-payer sales and move up the date and may be vermont can do with the will of the people seems to want whitfield then we can say as vermont goes. >> vermont is just dreaming. >> i recently read a report that says that there's a possibility

would start paying and drop a lot of people and you could see as a result people moving on to the government medicaid rolls do you think should that happen that what created a sort of i guess vested interest in strengthening medicaid that could improve the program to lead to single-payer. we are not sure what happens. we have rhetoric about what the employers will do and we have many employers who say they are going to drop coverage and then the public has customers that have risen up so we won't go there and i would encourage the public to do that.

i think frankly health insurance is certainly ingrained in the employer culture and expected to be by run a business on the health association and people want to know what the benefit package is. they are making employment decisions based on their benefit package. so i think there is a counterbalance to that and it always remains to be seen in the smaller moving target's they just recently projected that there may be some linkage out of the employer coverage system but that remains to be seen and i am optimistic that won't happen. please give our colleagues a round of applause. [applause] thank you very much for being here. the book will be for sale upstairs if you are interested.

present obama talks about measures for the gun violence. he will speak in denver after the approved a gun control measures.

people always like to ask me how did you come across the story. what happens a lot of times is to find a new story while you are supposed to be working on something else which can be a little frustrating at times and that is exactly what happened to me. i was doing a little internet research one day and this is the photo that i can across on the department of energy website and they put the littleness paper for one of the department of energy facilities and this newsletter said this month in history something along those lines. i looked at these machines and i was so sucked into it and the women looked lovely and had a nice posture and the 1940's hairdo of and i read the caption

and said these young women from tennessee were enriching uranium for the world's first atomic bomb however they didn't know that the time he was a guest speaker last february of the leadership program in colorado springs. he spoke of the future of the conservative movement. the remarks and questions from the audience are about 45 minutes i'm going to try to go by memory here and by inviting

me here and i just met her what a wonderful, wonderful president. please give her a hand. [applause] who did i get to the lastname right. she was the one that coordinated all of this and i would like to thank her for all of her efforts. i am not the easiest person to nail down on defense but this was important and she was able to persevere so let me -- i don't know where she is that think you so much and to the board of directors for -- is an honor for me to be here and talk to you today about something that is so incredibly important to me and that is our country. my parents immigrated with $10 in their pockets. it's true. the head of the scope and idea of what this country was like so when they can offer the world

and all of the stories about the american dream was true. my parents worked over and over again to try to make ends meet. they tightened their belts and worked harder. the first to leave college they took my dad with me because he tends to be the fun parent. he's just really get the and excited and i don't know if it is because the last child he was sending off to college or he had this thought of my goodness this is the first generation college. i don't know what really motivated the enthusiasm. it's a combination of everything that he was incredibly excited and walked around as if he were going to school himself and at one point he looked at me and he said your mother and i have done everything we could to get you here today.

we have never taken a hand out. you weld be a burden to society. they taught me i wasn't entitled to anything i didn't own the comer rm, worked for or pay for myself so growing up -- [applause] so growing up my life was centered around self-reliance and installed with all of the possibilities of letting the american dream. we have to remember what this country is based on and the america that i know it is based off of. it is based and grounded in the determination found in the patriots and pioneers. it's grounded in the beauty of our landscape the farmers that work them and the artists that painted them. it is an our heroic military.

it's in our olympic athletes. and yes it is and our children that look at the seemingly impossible and they say i can do that. most of all, let's not forget that the america that we know is grounded on freedom. that's what's important, that's what makes up our country. and it's interesting because you don't hear that from the leaders very much. you don't hear the word freedom. you hear a lot of slogans like hope and change and that is a great message because you can fill in the blank. it can mean anything. hope and change work for me, too. it's not necessarily the same message but we hear a lot of things like fear tactics, the messaging that wins right now is not what can you do for your country but the one based on what can the government do for

you. we have completely shifted and it's not a party shifted to complete philosophy shift and principal shift. freedom is what the country is based on and that is what we have to protect because we have to think about it. my parents left haiti to come to this country for what? for freedom, to escape the bureaucracies. the government was too big and people were too small. it's one after another. our entrepreneurs and freedom can have this crazy idea to invest their time and money and some things that just might work. free-market have to get more people out of poverty than any other economic system in the history of the world. [applause]

the sacrifice their lives what are they doing it for? it's not hope and change. it's freedom. you want to know why? because they know and we know in this room that there is no hope without freedom. that's who we are. that's the america that we know. so what's next? we have a president is elected based on what he said and not what he does because we wouldn't be in such a mess right now. so what do we do? do we hang our hat and say that's it, it's over trust me i wanted to do that several times i have children mid i don't have the luxury of doing that i want to leave you three things make

the choice to get into the fight and know why you are doing at. [applause] making the choice so many times you run on the slogans and that's why and i'm not telling you to get rid of the slogans of personal responsibility because we all believe in those things but understand really why you are getting into it. ask yourself if i can accomplish one thing while lying in office what would that be? if i have to spend every single political, every single political capital that i have, what i do? with that effort? as the mayor i ran on a slogan building a beautiful city, fiscal discipline and communication because i knew i could get as many people to come along with me as possible. but when i asked myself what i wanted to do if i could do one thing in the city it is to make

sure our city was run financially stable because i wanted to make sure the city that my children were growing up in and i was building around my family was a city that was financially stable between the national debt and state that i didn't want to put on another burden all local level. i believe the best most effective solutions were found the local level. so i will give you an example. saratoga springs was incorporated in 97. we had to state roads. really we didn't have anything to maintain. everything was agriculture. we had people had their own self sufficient systems. so the city didn't really have anything to maintain. so the city started to grow and grow with 17% in less than ten years. we never said a residential tax because we were living off of building permits. u.s. yourself how is that sustainable? how does that work? so guess what happened in 2008.

you can participate. [laughter] in 2008 the housing market crashed and we went from being able to build and work through with our issues for building permits to having zero, no money coming into the city. so we had to do something that was difficult. we've rolled up our sleeves and had to cut spending. let me tell you it is interesting. i lived in i believe one of the red states here in the united states and still you wouldn't believe how many people wanted to take my hat off for getting rid of the contest. it was insane. so we rolled up our sleeves and we got rid of as much spending as possible. and i was forced to ask myself three questions every time. is it affordable, sustainable and is it my job? when you ask yourself those

questions, it's funny cal little you are required to do. we went from $3.5 million which doesn't seem like much but when it's have the city's budget it's a lot of money, 3.5 million to $78,000 shortfall we make sure they do for nothing but public safety. the utilities paid for utilities, everything else has to be sustainable. it has to be our job. imagine if we were able to do that in washington. it's not rocket science. that's what my goal was. we are financially stable and we are doing well and those people that wanted to take my head off because the baby contest started

running it themselves as volunteers. it works out great. [applause] know why you were getting into the fight because if you know why you are doing and you can make a difference. number two, messaging and the power of personal touch. i know every single one of us has an iphone, ipad, blackberry, you name it. that is an effective way of communicating, wright? it is. ghosh, most people connect throop facebook, twitter, text messaging, we were just talking about this because bob says to tweet. sometimes it can get us in trouble. i will tell you a little story. i was actually sitting across the room from a friend of mine who happens to be a director at

the age utah department of transportation and we were sitting in a let's say it was a boring meeting and i had to do whatever i could to get through this meeting so he is text deneen backend fourth and apparently he was a board also. he told me to do something to shake up the meeting. he's like tell a joke and be funny. i meant to text and come and i will but i ended up testing date me and i will. laughter kawai didn't realize that until he looked at me from across the room with this look on his face. so i looked down and i see what i actually have done and i am sitting their like no i'm happily married. so any way if you look at your phone right now you'll see the ar is next to the teeth and you will see that i wasn't trying to date him but it's one of those things i thought okay i've got to be careful because that's the

way we communicate these days but when it comes to understanding who you really are and reaching people people are being tired of a reform letter. when something really needs to be said, when you need to communicate with somebody, that's not the best way to do it. how many of you have actually gotten a holiday message that said thank you so much for everything that you've done in our lives, loves so and so and you are trying to figure out of it is a group message or if it is actually for you. you are looking for any little area that says that was actually sent to just me. how many of you have done that? i look for certain things that say dear mia or something that you did that i can recognize but that is not what we do. there is a little girl that lived with her father in san diego and her father used to take her to these games that are

not heavily attended but she loved baseball. her father took her to the game one day and she was so animated and in to baseball that most people that sat around watch her more than the game. she started yelling that players and let the people in the audience and she was really into this game. well, while the game started going and people got a little bit rowdy and probably drinking a little bit too much fear the father took the daughter and took her to a section that was empty and as soon as they sat down there was a fly ball and it flew all the way over and landed in the section that she just moved from and this young man that was talking to this girl and really enjoyed talking to her caught the ball and the jumbo travon everybody could see this and he walks down to where

she is and gave her the ball and you can see this little girl just take her hands and blow him and kissed and everybody was into this. everybody thought was the sweetest thing. at the end of the game he was able to take his daughter down to get the ball signed by one of the players but instead she had this young man sign the ball and say thank you. she's got kids now, she's an adult and on her mantle is this a ball signed by agana man that she really didn't know, never really got to know and don't really know about his family or about his life but he impact of her life somehow. that's the power of a personal touch. people want to know that you know their story, that you understand their story and even

if you can't fix it the want to know that you want to try to fix their problems. that's where i believe we fail. we talk about numbers and we are right, but most of the time just think about how our president got elected not based on what he's actually done that based on how he communicates with people. we have to make people make the decision here before they make it here. the power of personal touch. the next time you are talking to somebody please remember their story because somebody else will see themselves in that story and to validate them and understand them. last but not least, we have to instill confidence and inspire people we face some serious

problems in our country. the problems of doom and gloom will tell you everything is lost. the economy is broken beyond repair. people are powerless to improve their communities. this nation is a nation in decline and or best days are behind us, not ahead of us. that's what they will tell you that everything is over. if you listen to the constant drum beats of the negatives, you will all believe that maybe they are right. even the most positive among us will have a hard time breaking up in the morning. how many of you felt really depressed november 7th so what do we do? i am here to tell you that there is a cause for confidence. confidence in some of our leaders that are out there in the battle trying and confidence we can improve our community come improve the places that we

live, fix the economy and improve the nation. for crying out loud, this is the united states of america and we've never been a nation of fear. [applause] at the republican convention i mentioned, and today i mentioned our determination is found in every child that looks at the impossible and says i can do that. how many of you have had a grand children or children watch olympic athletes do the absolute impossible and say i can do that? i know my son watched the trampoline event and went outside trying to perform everything they did and honestly believed he could do it, that's great. that's what we are madoff and if we remove that from the american people, which we are, then we will cease to strive for better and more. we have to instill confidence. that's the confidence you have

to instill back into the american people. confidence is not arrogant. true confidence comes from having respect for the challenge because we have got a challenge. being ready for the task, having a solid plan and having the determination to preserve because it is difficult. we have to do that. there are many people that told me after the campaign this is not the end. it's just the end of the beginning. there is so much more to do. i want you to know i have confidence that we can fix the nation's problems. we can simplify the tax code. we can have a budget and keep the promises we made to the seniors, we can keep the promises we've made to our children. we can work hard and make sure that we sacrifice a little so

that our children will have the opportunity to do amazing things every individual in the country should be able to walk confidently towards their goals. i have confidence in the american people. and as individuals and as a country we will not tell were in the corner. we will not drudged words decline. we will not go gently into that good night. we will instead stand up and stand out as examples of everything that's good and right in this nation. we need to do that. [applause] seeing you here today, you are my source of confidence. every time i go out and talk to people who were willing to get into that, i have a little bit more renewed energy so i would like to thank you for that.

remember our story. it's a good story. our story has been told for human struggle, standing up and striving for more, striving for better. i believe it is this type of confidence ronald reagan had when he says it's always morning in america. we have to start our mourning today. remember our story has been pulled in small steps and giant leaps from the woman on the bus to a man with a dream and the bravery of the greatest generation to the entrepreneur is and innovators of today you know what that took? the choice to get into the fight, messaging, touching people personally. it took freedom to make those choices and it inspired confidence. all the people who have some amazing things inspired confidence and that is the task that we have to accomplish.

if you will join me in this fight, i will not give up if you don't. if he will join me, we can add our voices to this cause and make sure the america that we know and love is the america our children will possess for years to come. god bless you all, thank you for having me and god bless this great country, the united states of america. [applause] >> she has consented to take a few questions and for those of you that have been here before we can show everyone else how what's done. there's a couple microphone's over there. line up behind them and we will alternate microphones when you are recognized state your name,

tell us where you are from and fire away. we will go over their next. >> from bloomfield colorado the class of 2011 what is next for me politically? >> i'm keeping my options open. we have opened up an exploratory committee and so we are going to see if we can get the base is going again. but like i said before, i will not give up if you don't give up. i cannot do this on my leone. we need as many people behind us as possible, and we need to make sure that we are -- that we have this message of individual liberty and freedom and we are able to make sure that we get

out and inspire people comments by your everyone. i was able to go to the university of chicago the other day which was a lion's den, and what was interesting is i reminded the students that tough things come through service and even though they are hard, they are in the end of perfect and one person asked me how can you be black, female, conservative in today's america, and i pretty much told them it's because i refuse to fit in this mold in this form that the society wants me to fit into. [applause] >> imagine if martin luther king decided to sit back and do exactly what the society told him to do. if he decided that he was like okay they know where my place is.

i don't know where my place is. our our battles so different today than they were then? are our battles so different when we were able to pass the 13th amendment back then? are they different than today? they are very, very different circumstances. so why will not give up. that's the answer to the question i will not give up. we will continue to fight and to be out there one way or another. one of the criteria when you were analyzing the budget success was asking the question is it our job to do this and i would love to know what are some of the things that you've looked at and said no that is the people's jobs, not the government jobs, and looking at the federal government what you think are some of the things that should be questioned in the

same way. .. >> but it is truly in essentials service, then you can do it purpose of the residents said we will go out and do everything we can to collect books. they collected all books

what they did not they've repaired and sold. they got the private businesses to sponsor the library, a bank of america sponsored the childrens' library. we were not just building a library but a community because people started to get together for the same cause. on monday night everybody was there. the library was making money we would have movie night. today we have a full-blown library not on the backs of the taxpayers. [applause] and what's interesting is i was there the other day. my children volunteer for the literacy program and of little boy a dropped some gum on the carpet and the mother said pick that up or i will have to fund raise to replace that carpet. [laughter] picked it up.

the so it is interesting when we know something and put time and effort into it how much people really take care of what they have worked hard for. [applause] you did ask me one more? what can federal government? it is written right there in the constitution. [laughter] i don't know what else to say. it is clear so if they just follow that we would be okay [applause] >> welcome to god's country. class of 2013 i am curious to hear your thoughts of the unique role of women in leadership. >> eww.

[laughter] what made me a better candidate is i did not need the job. my husband who is sitting right here, he finances everything i do. [applause] i would not be able to do what i do if not for that great man we have over there who feels through me she is sacrificing also and doing his service. but gannon have a lot to offer. i was the pta mom for many years laminating the apples of the popsicle sticks realizing the department of education making over $100,000 while teachers make pennies. we go to the doctor's office with our kids and every time we go grocery shopping less is coming home as the prices go up.

there is a lot for women to offer. i am, and just to let you know, i do not always stand on the podium to say i am woman, hear me roar. i am a wife, mother, a concerned citizen, american citizen, american, we need to make sure we don't allow anyone to divide us. the war on women is ridiculous. [applause] but i need as many people to get involved as possible to make sure their children have an opportunity. figure. >> i am from estes park colorado with messaging with the personal touch when we saw president obama attacked the second amendment he

surrounded himself with children. why don't our congressional leaders take a page from that book when they discussed the budget and the budget deficit and the national debt surround themselves as children and say you just mortgaged the future of each of these taxpayer children will inherit $380,000. >> i have so much to say about that. we play this game. irate -- realize this in the campaign we play by the rules. we are the only ones playing by the rules. [applause] and in our heads we think why would we use our children even though we do everything we can to protect our children? i woke up one morning when news blood negative morning at the news plastered mia

love does not like autistic kids saying i would eliminate funding for these students. but they will win at all costs. we have to be smart with personal messaging, yes, i do believe we have to do what we can do what we have to do they have to have a voice there the ones that will suffer the most we have to speak up for them so as long as we are not doing anything to put them at risk quarter exposing them in inappropriate ways we need to paint a clearer picture of who we are affecting and if you don't care about yourself, care about these kids. i agree. but we have to make sure whatever we do our principal

stay intact the and we can sleep at night. [applause] >> thank you for taking my question diana from africa. i am pleased to be a sponsor and my question is the greatest lesson i have learned from this nation, is this nation is built upon the phrase is in god we trust. [applause] what do you think about that and where is that pillared

now? >> thank you you are right. i believe the majority of people are god-fearing i know i have a moral compass based on my faith and what i believed but also we have to make sure that we have to understand my principles. the other thing to make this country great, you can worship who you want to worship and how you want to worship and allow people to make decisions. the greatest confusion people have that i believe has been clouded, we are not supposed to be free from consequences. we're not supposed to be free from failure. with the believing god or choices you have to reap the benefits are suffer consequences.

to practice my faith that want to make sure other individuals practice their faith. i do believe in a guide. i do believe i could preserve the opportunity to teach my children in my home what i want them to learn and not have somebody else teach my children whenever it is. if you get federal government to do one thing they have the power to do the exact opposite also that is why my principal stayed with me. individual choice and liberty reap the benefits benefits, suffer the consequences. [applause] >> arapahoe county class of 2012, you talk about your mother and children and you were involved pta and mayor of the community i am the new president of a new

nonprofit focusing on educating fifth graders of the u.s. constitution get the document in the schools and getting them involved in the process because learning does not start with the less starting in third grade with things like global warming and gay-rights. if you talk to the importance of reaching children, a founding principles and founding documents and what it means to be an american at a young age. >> there were a lot of questions in there. [laughter] let me see if i can answer what you're asking me. government takeover of education, health care care, regulation, businesses is very real. as much as you say they start early, i want you to

know i live in a red stay and my children are coming home with articles, there was one my child came home with talking about the president's jobs plan and at the end it said the jobs plan, the right plan for today and she has to write an article but she has an opinion so when i say limited government, it doesn't mean you eliminate everything. it means everything is applied at the appropriate level. education applied at the most local level is the most effective and the best solution we can have. [applause] when it comes to teaching our use, we have got to make sure federal government is not educating our children.

we are educating our children. [applause] that is how we will start. if we allow them to educate our children, what next? they will grow up with ideas and thoughts that are not necessarily a hours. >> thank you for coming i am a graduate of lp art 22 -- 2002 and we're for americans for prosperity in the 200856 percent of women voted for the current died in 201255% voted for the occuring guys so what you suggest how do we educate women in america that the policies of the left are not helping us but hurting us >> it is all messaging somehow we are then on

compassionate hard, a strict warmongering party somehow. the waiver able to do that is by messaging. they voted with their hearts before their heads but we try to reach the headfirst and it doesn't work that way. we are losing. we have to make sure let's talk about people. i have heard so many stories about moms, a health care that fit the message but we have to start telling those stories. who remembers joe plummer? he has a name and face and of voice hours do not have a name or a face or a voice we

need to take individual stories and tell those does that make sense? it is all about messaging if we could get people here they will make the decision there. >> you motivate all the fuss >> thank you for coming. i am a graduate of 2010. i got my last name from the soviet union so your story resonated with me. i hope one day my daughter is on a stage to talk about how her parents taught her the value of hard work and dedication. as conservatives we cannot offer outcomes but opportunities and the flip side is failure. ever competition offers outcomes we promise a safe

and risk free world and we can't. we tell you you can have the possibility of your dreams cannot deliver them for you. powdery message that to make it appealing to those we need to? >> there is the rub. one of the things we need to do do is get back to the core beliefs. how can somebody be independent and free when they are completely dependent on the federal government collects when i talk about certain things on the road i talk about we are fighting the same battles as the 13th amendment. instead of the enslaved by the plantation owner now all americans are enslaved by a federal government. what's happening is if you cannot provide for yourself or make decisions for yourself, you will never be

able to reach your potential or opportunity. the policies we created day brings everyone to the lowest common denominator. when the free markets free up it takes everybody from the lowest common denominator and brings them up. it is something i believe is very difficult but i will talk about individual stories. people like you can see yourself in my story. when i talk about other people and their stories someone can see them in that story. i saved you want your children to have a better life than you had? been you have got to be able to make mistakes and fail. my father failed many times but he got back up. through that i was learning. this is not about freedom

from failure but the opportunity to reach your full potential. it is a difficult message but we have got to get out and talk about individuals and their problems to make their lives better. [applause] >> class of 2009 and a business person here in colorado i have the privilege of spending a decade overseas starting companies but you have a unique background of what is our role as a country to help other countries or other people who put money into developmental aid what is the perspective? >> that is interesting. during the earthquake in

haiti i still have people in haiti and i am glad this is the last question because i have a message with that. during that time i was getting messages through family members of the situation and i know where people in this state of utah that went to help the and i know people in haiti. here is the thing. we as americans have given more voluntarily banned any other country. to i believe we have an opportunity to care for those who cannot care for themselves? yes. do a belief if we have the resources to help our neighbors who are suffering, should we do that? yes. i do. but the day we decide we need federal government to force us to do that that is when we declined as a

society and the last american. [cheers and applause] that is not who we are. in my city we dealt with the fire and then a flood right after that. 22 homes were absolutely devastated. if i can show you pictures, water from the bottom. people said what will you do? if there was ever a day i wanted to throw my hand that to say $830 per month was not worth it, that was the day. i was gone for three days straight, my basement's was an they're shoveling and the next morning after the flood , i got up and went

over and 5,000 people showed up shovelling the muds -- much out of basements and when they asked me the question what will you do? will fema come and help i said we will have this cleaned up before washington even realizes we are on the map. [applause] through volunteer efforts we could clean up those basements in three days, through our own efforts to fund-raising and help people repair their personal property. hard work, education, a thrift, a savings will take us far beyond than any government program ever promised. volunteer work, that is who we are. that is a we need to be. that is out be remind people how we will get back on our feet. thank you so much.

i appreciate it. go out there, work hard and don't leave me out there alone. thank you. [applause]

>> i am pleased to be doing today. >> i speak for the mothers. >> we will stop again. >> pakistan, somalia.

>> please remove them. >> you even refuse to tell congress they will not tell congress that we are killing children. >> please. >> senator weinstein. >> please expedite the removal. >> pakistan are more important, i do your jobs. >> please proceed. all right we will stop the hearing and i will ask that the room be cleared and the code pink associates not be permitted to do come back. we have done this five times and that is enough.

>> actually it is significant as it has been preserved all these years. at one point* there were 30 or 40 of these around the valley. now on only a couple have survived. most were smaller about one-third the size of me said ron day and also pueblo grande day. but these mounds did survive its allows us to learn about the lifestyle and also how

complex the social and political organization was. we thought with archaeology one of the things we have as we look into the past to see what they did it gives you hope for the future because if they could do this in the desert what can't we do?

[applause] thank you for coming out we appreciate you having you here also those who are on twitter at #"politico" breakfast we have senior advisor to the president dan pfeiffer do talk where they have been, where they are going and those who have spent time with the president to give us a window into what is going on we would like to think bank of america for their continued partnership this is an important forum with issues that matter most in washington and we are grateful for the partnership

going forward into the of new year. playbook breakfast i think i said the wrong earlier and i will get your twitter questions and get you in to you the questions with the cards going around. without further delay, dan pfeiffer. [applause] >> you on like "politico" in that, this is like lunchtime? white house's start very early. where are you if your day? >> you would be the middle of the third meeting of the day depending on the morning start at 7:00 in the morning, read the papers,

then expanded senior staff and communications staff meeting to include j kearney and some of their staff. depending on the day sometimes it is 12 hours or 13 or more but. >> for all jobs in washington you don't know how your day will be some days are long and some days are better. >> today the president is in colorado talking about guns and you will be joining him on the west coast over the weekend in connecticut talking about guns. it seems the air has been coming out of the part we thought was a no-brainer. >> i read some of the stories that suggests that. >> they are not stories they are facts. >> it is not a fact to the

american people. i rarely run into 90% with background checks. people in washington may be looking for a way out to make progress but around the country the president has traveled and met with families with mothers who have mobilized some who are victims or just motivated from connecticut and elsewhere and people feel very strongly. you don't want to get on the wrong side of the 90 percent of the issues. >> a lot of people are in "politico" the of the day they said newtown may have changed american but now washington. >> it is a lot lagging indicator. >> on guns? >> no question 90% we should not be having this conversation that heading towards a solution of the problem. i am optimistic we can work

something out to. of all issues, people and washington talk about winners and losers, and never suggest to right suggest there are winners or losers and a "politico" even and but this is a life or death issue either they will make progress and people's lives will be saved or they will not. they are at risk. that is serious. >> put aside the talks but will the president do to really push senators of both parties of the tough races races, of what worst trading will he do or how much so will he do to get the tough votes? >> it is clear sense newtown the president has put a lot on the line to make progress and he has talked to the senate democrats as a whole twice to make the case and

working very closely with the senators, senator schumer and others but here is what i know. we have overwhelming numbers of democrats and underwhelming numbers of democrats so they have slept -- stepped up to the plate and try to do the right thing but the question is will we get every single one? absolutely not. you cannot expect anonymity. >> will the president privately twist their arms and go lbj on this issue? [laughter] >> he will make of very aggressive case to both parties why this is the right thing to do. >> we've lived in a divided

government to live in a world where the republicans made 60 votes the threshold for everything. if they blocked if they can do that. it is a significant political consequences. with that the general political party right now. i read reports, the autopsy. [laughter] and it is a good report i give that a group credit for speaking truth to power but i will say the only people that should have read the reports are the rnc, myself and people in the room because flies in the face of what they we're doing getting on the wrong side of the 90% issue. >> then there is no

republican in the house 2014. >> and continuing to reinforce the idea you are the party that caters to the 10% or is out of touch with mainstream america and alienates the demographic groups that move away from the republican party contributes to that. with you look at all the areas where every smart republican has looked at we have trouble with these groups to decide you block, and sends them legislation with large red geordie of gun owners does not help the situation. >> with the president signed a gun bill? been a key ones do signed a strong this bill he can find what is a lot today? , a stronger can remake it? >> he would sign it? >> whenever we do has to be

better than current loss of we will look at any compromise and base it on that if we can save just one knife then that is one way. >> give your twitter handle. >> pfeiffer44. >> tell me where you are at since the inauguration. >> what have we been able to accomplish? we talked about the secretary and people considered if it is time to use day or do different things or move on and you'll

never have a better opportunity to do more but that is a metric we're using for any give vent way. >> so it is driven by metrics. >> the first your the new term was successful? >> the way to look at it the motivating factor got the president into national politics in 2008 was out of the help the middle class? we let the economy and what we can do to help the average person and if we make progress then the senate.metric is there is a series of campaign promises are we making progress on those? a huge campaign promise and

to talk about gun safety with newtown will be helping balance the economy so it is not top down but what we can accomplish with the fiscal cliff that was progress. >> next question and be specific because you are just a handful who know the actual answer to this of course, with the obama advisors jittery 21st 21st, 2017 success looks like what? >> he is determined to do what? >> our metrics for the first year are the same. >> three wasted years? >> more promises on the

campaign promises to improve the economy is the housing market getting stronger? immigration reform? is the middle-class way of life cheaper for people? has obamacare been implemented successfully? are we miti are metric? is wall street reform being implemented? we continue to make legislative progress to we make real progress with the energy and climate? so we will see how much progress we have made if they stayed true and what he ran on then it will be a success. >> you a handful of people who'd actually knows what the president is thinking moment to moment. your first day was martin

luther king day 2007, tell me what yowas martin luther king day 2007, tell me what you did. >> not everybody talks about the obama campaign as a big billion dollars enterprise. our first day was spent with the international press secretary standing outside waiting for robert kids to pick us up to. >> now he has a driver. >> he drives the chevy pulled all around town we went to a little rented office right around the corner from here on connecticut and there are six of us we have no internet somebody had to go to staples for a router and to go from where we are right now or even 16 months later, it was a basic of a

start as you could imagine for the high-flying enterprise. because unlike others, a the president did not plan for it for years only the idea was it a few months before he announced so we were always on the wings as we would take off. our sparse beginnings are hard to imagine for those who showed up a few months later. >> speaking of bill burton "politico" has a great story with the headline obamacare trash talkers and these are those who are unplugged so give us a window how you talk when we are not around. what do you make of the commentary? >> i saw the story and was somewhat amused.

they're not that blind or aggressive on twitter. >> he may be upset that you say that. this is not a noosing before twitter was invented you would see karl rove on cable television making the case. this is about a new medium. when people leave the white house they are not required to give up their opinion. >> talk about that. they're making the case with the authority of having been there but you don't have to own it. >> to read grand strategy

is, it is like a handful of people all who are close friends doing what many reporters are doing and the discussions they are having is a window into how a former aides to the president just like the reporting now gives the inside on the personal opinions from personally unknown because of these nature. >> what is the most illuminating tweets by a reporter? how we think or how they think that left an impression? [laughter] >> i don't want to single anybody out but some reporters, that we put it this way how twitter has changed a lot of things and

politics and society but because of twitter every reporter with the scandal has the capacity to do analysis. john harris and those who'd covered a the campaign they don't know to distinguish between the 22 year-old and the big foot political reporter who covered six presidential elections. with the analysis is done to give us a window how our motivations are perceived it

treats it like a grand plan the former aides will go out there is the furthest thing from the truth. i know the conversations but it is not how works. >> something you are bipolar you take shots at the riverside and how really committed is a the president? is he really changed? it was once said they don't really change they just get more like themselves.

>> the president ran cover the history long before the senate is to try to get together with people of different points of view to get things done. it is one of the reasons he and the senator from oklahoma who agree on almost nothing, they are friends but could work in the senate together and why he works on the issues now. but the question is it takes two to tango. there are some in the senate that are sincere to get it done but he is secure but the president is not bipolar or bipartisanship but washington is. half the time we read

stories that we should reach out more and have more dinners and play more golf then if we do that then they say the president is caving why is he being reasonable? but you have to do both. we will do whatever we can get done. >> visible on for months? >> he has a dinner scheduled one week from today and will continue to reach out to republicans and democrats. >> more dinners? >> absolutely. we will limit the summits but there will be the exchange of food and drink. [laughter]

>> talk immigration. how you give senator marco rubio room to sold the deal to do conservatives? from senator shiver to do so and praising the package how does marco rubio sell it to the rest? >> there is a general consensus among republicans they need to do comprehensive immigration reform. this is not be entirely democratic issue. one of the largest advocates for reform was president bush and his political divisors and the chamber of commerce has been an advocate. only in recent years only far right has polled the

reform away from it and this is a great tribute when republic since come around. the consensus is it needs to get done. all that matters to him and is common sense comprehensive bill that is consistent with principles. >> how likely about broker? >> the devil is in the details. that the question is whether the house republicans can do the right thing. i think it is in a better place than people thought it would be a few months ago. ferris is sincere efforts for those in the senate that

it only matters that we get this done the best way is to be out front pushing for it. >> what is your current calibration? >> why this is important he did interviews last week and will be traveling in weeks to come but will make the case privately and we working closely with the gang of eight to help them with technical assistance assistance, rating the bill. and we will praise them to do the right thing. it is the rare moment washington is working right now. >> what about 2007? >> his is changed like americans. he reads the news on the eyes had so it is more

realtime, and seeing different sources, so not long after running for president he stopped watching cable tv it was driving an insane to be caught up in a minute to minute effect he is a big supporter of long form journalism he reads a lot of magazine pieces from "the new republic", atlantic, not the issue of the moment but the in depth look at things and a lot of times he will send a note to say you should look at this. >> what are others? >> because of the way this is how people change and consumer information, this president access is a lot of

magazines you not tell you who he subscribes to. [laughter] but you will read something online or a reference to another article. of good example is taylor branch n.c.a.a.. he may not have stumbled on that on his own but got information and read it and was struck by its. >> there were stories about how he pushed around there is something like that right now with the agenda? >> not at this moment. >> a particular book? >> he has been reading the allots of magazine pieces. he reads a lot of history to get away from the day to day

of politics espn, a sports magazines, of "rolling stone", magazines like that but you need a break once in awhile. >> so if you as the staff has to cope with that no other has that it used to be the president got the news summary or you knew what he was seeing. this president serves around and you don't know what he has read. >> true. sometimes he sees things before i see them and will point* them out to us. >> i am sure he enjoys that. [laughter] >> i do. in some ways the first modern president who use the internet on a regular basis, e-mail, he has the

ipad. he consumes information it differently and it is useful because it is very easy in the white house to be caught in the bubble and even to read things differently and are presented it is useful for the way he thinks. >> in addition to inks. >> in addition to the ipad there was the story of the bionic blackberry. does he still have that? >> he does. i never understood why it was bionic bible take their word on that. >> we talked about of view of your techniques and we will see if you will plead guilty or plead no contest this softball interview with a television personality you feel comfortable with? >> not gu